THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


ji.  &■  ^*^*^^' 


Fig.  I. 

FUNERAL   URN.   WITH  ANCIENT  PERUVIAN   LABOR  SCENE. 


LABOE 


PRIMITIVE   PEOPLES. 


THE   DEVELOPMENT    OF  THE    OBSTETRIC    SCIENCE    OF   TO-DAY, 


FliOM     THE 


NATURAL    AND    INSTINCTIVE    CUSTOMS 

OF 

ALL   RACES, 

CIVILIZED   AXD    SAYAGE,    PAST   AXD   PEESENT. 


By  GEO.  J.  ENGELMAN:^,  A.M.,  M.D. 

Professor  of  Obstetrics   in  the  Post-Graduate  School  of  the  Missouri  Medical  College 

Master  in   Obstetrics  of  the  University  of  Vienna.     Fellow   of  the   American 

Gynecological   Society;   of  the   London   Obstetric  Society;  of  the 

Pathological   Society  of  London,     Consulting  Surgeon  to 

the  St.  Louis  Fenna'e  Hospital ;  St.  Ann's  Lying-in 

Asylum  ;   Mexico  Hospital,  etc. 


SECOND  Edition— Revised,  Enlarged  and  Re-Arranged. 


FIFTY-NINE     ILLUSTFilTIDNS, 


ST.  LOUIS : 
J.  H.  CHAMIiKRS  &  CO. 

1883. 


Re-entered  according  to  Act  of  Congress,  in  the  year  18S3, 

By  J.  H.  CHAMBERS, 
In  the  office  of  the  Librarian  of  Congress  at  Washington. 


AlO 


INDEX. 


CHAPTER  I. 


PKEGNANCY,  PARTURITION  AND  CHILDBED. 

VAC.V. 

Pregnancy 1 

Parturition 7 

Comparison  of  labor  among  civilized  and  savage  races 7 

Accidents  in  labor  among  primitive  people 10 

Superstitions  and  customs 11 

Place  of  confinement 12 

Couch 14 

Assistants,  midwives,  etc 15 

Kind  of  assistance  rendered 17 

Expression 18 

Fright 19 

Medicines,  herbs. 20 

Childbkd 22 

Treatment  of  the  mother 22 

Treatment  immediately  after  delivery 23 

The  binder. 25 

Time  of  rest  accorded. 25 

Diet  of  the  lying-in  woman 20 

Medicines  used _ 30 

Management  of  the  child 36 

The  bath -  37 

Time  of  applying  the  child  to  the  breast 38 

Period  of  nursing 39 

Weaning 39 

Food  given  in  addition  to  the  breast. 39 

Medicines  used. 41 


INDEX. 

CHAPTER  II. 


POSTURE  IX  LABOR. 

TAGE 

Introduction 51 

Origin  of  tliis  paper 51 

History  of  the  subject. 52 

Plan  of  the  investigation 64 

Division  of  the  subject 66 

Assistance  received  in  the  work 67 

Geographical  Distribution  of  the  Various  Positions 58 

PART   I. 

Position  op  Parturient  Women  Among  Peoples  Whose  Labor  is 

Governed  by  Instinct,  and  Not  by  Modern  Obstetric  Fashion..  g1 

^—Perpendicular  or  upriglit  posture 61 

1.  Standing 61 

2.  Partially  suspended 64 

3.  Suspended 68 

£— Inclined  position 70 

1.  Sitting  erect 70 

2.  Squatting,  as  in  defecation 72 

3.  Kneeling. 78 

a — The  body  inclined  forward 79 

h — Knee-hand  or  knee-elbow  position 89 

fti — Inverse  knee-elbow  position 93 

c — The   body   erect,  inclined    backward  or  partially  sus- 
pended   97 

d — Kneeling     postures     where     precise     descriptions    are 

lacking 103 

4.  Serai-recumbent 104 

a — Sitting,  semi-recumbent  on  tlie  ground,  upon  a  stone  or 

stool 105 

h — Sitting  on  the  lap  or  between  the  tliighs  of  an  assistant, 

who  is  seated  on  a  cliair  or  on  the  floor Ill 

c— The  obstetric  cliair 120 

d — Semi-recumbent  position,  strictly  speaking 127 

C — Horizontal  or  recumbent. 134 

1.  The  dorsal  decubitus 134 

2.  The  lateral  decubitus 138 

3.  Prone  upon  the  stomach 139 

part  II. 

The  Position  op  Women  Among  Civilizkd  Kaces  ok  tiik  Present 

Day  in  the  Agony  op  the  Expulsive  Pains 140 

Resume  and  Conclusions 144 

R(3sum6  144 

Conclusions 148 


jyDEX. 

CHAPTER  III. 


THE  THIRD  STAGE  OF  LABOR. 

TACiE 

Introduction 152 

Management  of  Simple  Cases 154 

Placenta  delivered  in  the  same  position  which  has  been  occupied  dur- 
ing labor-pains  and  the  expulsion  of  the  child 154 

Manual  expression l-'»4 

Intra-abdominal  pressure 158 

Traction  on  the  cord 159 

Delivery  of  the  placenta  with  the  patient  in  a  different  position  from 

the  one  occupied  during  the  expulsion  of  the  cliild 160 

Management  of  tub  Placenta  in  Case  of  Retarded  Expulsion....  163 

Management  of  the  Umbilical  Cord 166 

Peculiar  Superstitions  and  Customs 172 

Conclusions 173 


CHAPTER  IV. 


I\1ASSAGE  AND  EXPRESSION. 

Review  of  the  Subject : 176 

^1 — History  of  Massage 177 

Ancient  times 177 

Middle  ages 178 

Various  manipulations  practiced 178 

Physiological  effects. 179 

B — History  of  External  Manipulations  in  Obstetric  Practice....  180 

Only  help  in  difficult  labor 180 

Saying  of  Hippocrates 180 

Greece  and  Rome 180 

Savage  races  of  the  present. 182 

C — The  A^arious  Kinds  of  External.  Manipulations 183 

I.  Pressure: 

1.  By  the  arms  of  an  assistant  encircling  the  patient's  ab- 
domen   183 

2.  Bandage  tightened  by  assistants 185 

3.  Drawing  the  abdomen  across  a  rope  or  pole 187 

4.  Stripping  do-\\Ti  the  abdomen 188 

5.  Expression  by  means  of  the  feet 189 

C.  The  belt 189 

7.  Pressure  against  a  staff 190 

8.  Lying  prone  upon  the  stomach 190 


vi  INDEX. 

FAOB 

II.  Massage ^^1 

III.  Shaking  up  of  the  Patient 194r 

IV.  Permanent  Pressure 194 

B — The  Uses  of  Massage  and  Expression 195 

I.  In  pregnancy 1^^ 

1.  Correcting  malpositions 195 

2.  Producing  abortion. 196 

II.  In  labor 19<> 

1.  In  normal  labor 196 

2.  In  malpositions l^*^ 

3.  In  the  expression  of  the  placenta 1^" 

III.  In  childbed 19" 

E — The    Dkvelopment    of  External  Manipulations  in   Recent 

Obstetric  Practice 197 

Literature 199 


CHAPTER  V. 


CHAEACTERISTIC   LABOR    SCENES   AMONG  THE  YELLOW,  BLACK 
AND  RED  RACES. 


Mongolians 201 

Japanese 201 

Karafuto  Ainos. 204 

Position 205 

Delivery  of  child 206 

Placenta 206 

Kalmucks 207 

Negroes 209 

Religious  ceremonies  and  superstitions :  209 

Pregnancy 210 

Parturition 210 

Afterbirth 211 

Lactation  and  childbed 211 

Red  Races 213 

Indians  of  the  Pacific  Coast , 215 

Preparation 215 

Labor,  simple  and  complicated 215 

After-treatment 218 

Walking  and  compressing  abdomen 218 

Lying  near  fire  warmly  wraijped 219 


INDEX.  vii 

PAGE 

Eastern  Tribes 220 

Shelter  for  confinemeut 221 

Delivery 222 

Medical  treatment 223 

Management  of  afterbirth 224 

Five  day  periods. 22G 

No  flesh  eaten  by  husband 22G 


ILLUSTRATIONS 


FIG.  PAGE 

1.  Funeral  Urn  with  Ancient  Peruvian  Labor  Scene Frontispiece. 

2.  Temporary  Shelter  for  the  Lying-in  Woman :  Coraanches  13 

3.  Japanese  Lying-in  Couch  and  Supports  used  in  Childbed 15 

4.  Labor  Scene  among  the  Wakambas  (western  i^ortion  of  central 

Africa; G3 

5.  Mythical  Labor  Scene  from  Academy  of  Medicine  in  New  York 64 

6.  Bruld-Sioux,  Standing 65 

7.  Ceram,  standing,  semi-suspended 67 

8.  Southern  Negress,  suspended 69 

9.  Sioux  Squaw,  seated  cross-legged  on  the  ground 72 

10.  Pawnee  Labor,  squatting,  back  to  back 74 

11.  Squatting  Posture  of  the  Tonkawas 75 

12.  Obstetric  Position  of  the  Persians — ^From  Floss  (after  Pollak  and 

Hnontsche) 77 

13.  Southern  Negress,  kneeling,  arms  resting  on  chair 79 

14.  Blackfoot  Squaw,  kneeling,  resting  upon  a  staff 82 

15.  Comanche  Labor,  mth  Scene  of  Surroundings 84 

16.  Chippewa  Labor»  kneeling,  inclined  backwards  87 

17.  Framework  formerly  in  use  in  Japan  for  the  support  of  the  partix- 

rient  in  a  kneeling  posture 88 

18.  Sitting  Posture  of  the  Japanese,  customary  in  Childbed 89 

19.  Kootenai  Squaw,  knee-face  position  with  assistant  astraddle 92 

20.  Position  for  the  Delivery  of  very  Fat  Women  (Melli) 94 

2L    Delivery  of  a  Fat  Women  in  Medieval  Italy 96 

22.  Modification  of  the  position  for  Fat  Women 96 

23.  Images  from  the  period  of  the  Mound  Builders 100 

24.  Northern  Mexico    101 

25.  Coyotero  Apaches,  difficult  Labor 102 

26.  Kaffir  Woman  in  Labor 106 

27.  Oronoko  Indian,  seated  semi-recurabent  in  hammock 108 


^^iii  IXDEX. 

I'IG.  PAGE. 

28.  Labor  Scene  in  Ancient  Greece,  group  in  the  Cesnola  Collection, 

New  York HO 

29.  Modern  Cypriote  midwife's  chair,  Cesnola Ill 

30.  The  Scientific  Posture  Advocated  in  the  16th  Century.     From  Joan- 

nes Michaelis  Savonarola,  1547 113 

31.  The  Obstetric  Couch  in  the  Rural  Districts  of  Ohio  in  1845 115 

32.  Semi-recumbent  in  the  Husband's  Lap,  assistants  holding  hands  and 

knees,  Virginia. 116 

33.  Semi-recumbent  in  Lap,  Virginia 117 

34.  Andemanese  Labor  Scene 119 

35.  Origin  of  the  Obstetric  Chair  (Engelmann)  120 

36.  Development  of  the  Obstetric  Chair    (from  Goodell).     Chairs  of 

Savonarola,   1547;    Eucharius  Rhodius,    1544;    Deventer,    1701; 

Stein,  1805 •. : 121 

37o    Delivery  in  the  the  Obstetric  Chair ;  after  Rueflius,  1637 124 

38.  Obstetric  Chair  now  in  use  in  Syria 126 

39.  Favorite  Posture  of  the  French  Canadian 128 

40.  Japanese  Labor.     Instrumental  Delivery 129 

41o     Penomonee  Labor 130 

42.  Birth  of  the  Emperor  Titus,  from  Ploss,  after  an  antique  painting 

on  the  celling  of  a  room  in  the  Palace  of  Titus,  on  the  Esquiline 
Hill  in  Rome 131 

43.  Labor  Scene  in  the  Rural  Districts  of  Virginia;  semi- recumbent  in 

bed 132 

44.  Couch  and  Lying-in  Chamber  of  the  Siames.     From  Ploss 137 

45.  Crow-Creek.    Prone  upon  face  and  adbomen,  across  a  pillow 139 

46.  Semi-recumbent,  in  the  agony  of  the  expulsive  effort 142 

47.  Kneeling,  clinging  to  rope 146 

48.  Manual  Expression  of  the  Placenta.    Penomonee  Indian 157 

49.  Use  of  the  Squaw's  Belt.     Sioux  Indian.  161 

50.  Placental  Expression  as  Practiced  by  the  Indians  of  the   XTintah 

Valley  Agency. 162 

51.  Placental  Expression,  Mexico 164 

52.  Vessels  in  which  the  Placenta  is  Buried,  Japan 173 

63.     Bandage  as  used  in  Mexico 186 

54.    Management  of  Difficult  Labor  in  Siam 188 

55-     Massage  and  Expression  as  Practiced  in  Mexico 191 

56.  Position  of  Japanese  Woman  in  Labor  and  Arrangement  of  her  Couch  203 

57.  Kiowa  Labor,  drawn  by  a  Kiowa  Indian  214 

58.  Mexican  Indian  in  Labor,  showing  posture  of  patient  and  assistants. 

From  photograph  taken  near  San  Louis  Potosi,  by  Dr.  G.  Baaroeta.  217 

59.  Kiowa  Midwife  blowing  an  emetic  into  patient's  mouth.    Drawn  by 

a  Kiowa  Indian. 222 


CONTENTS 


CHAPTER  I. 


PREGNANCY,  PARTURITION  AND  CHILDBED. 
Many  points  of  resemblance  to  the  customs  of  a  more  advanced  civilization. 

PuEGNANCY. — Its  importance — Rarity  of  abortion — Testing  the  value  of 
conception  in  the  seventh  month — Anxiety  for  male  offspring — Signs  of 
pregnancy — Careful  treatment  of  pregnant  women — Peculiar  super- 
stition of  the  Pahutes. 

Labor. — Short  and  easy — Rarity  of  accidents — Comparison  of  labor 
among  civilized  and  savage  peoples — The  most  common  accidents — 
Their  treatment— Special  rooms  or  huts  used — Superstitions — Labor 
usually  private— Couch  used— Old  women,  occasionally  so-called 
midwives  assist  the  parturient— In  difficulties  a  priest  or  medicine 
man  is  summoned— Assistance  is  simple— Various  external  manipu- 
lations— Towel  about  abdomen  —  Expression  —  Rubbing  —  Fright- 
Teas  and  herbs. 

Childbed.  —  Immediately  after  delivery  some  walk  about  —  Others 
plunge  into  a  lake  or  river — warm  water  used  by  Sclavonians — Fire 
—A  binder  rare— Time  of  rest  accorded  is  brief— Immediate  work 
among  some  peoples— Diet  rarely  changed— Some  medicines  are 
used— Father  sometimes  dieted— Free  flow  of  lochia  encouraged— 
Sickness  rare  —  Child  dipped  into  cold  water  — Strapped  on  board 
— Kanikars  apply  child  at  once  to  breast— Kalmucks  and  others  do 
not  suckle  for  first  three  to  live  days— Period  of  nursing  varies  from 
two  to  five  years— Weaning  by  asafetida— Poor  food  cause  of  sick- 
ness and  death— Kinds  of  food  given  the  child— Medicines  used. 


CONTENTS. 

CHAPTER  II. 


POSTURE  IN  LABOR. 

Introduction. — 

Origin    of  tliis    paper — Ancient  Peruvian  Urn — Rigby — Ploss — Ludwlg 

1  — How  to  study  the  natural  position  of  women  in  labor — Plan  of  this 
investigation — Conclusions  reached — Thanks  for  assistance  render- 
ed— Geographical  distribution  of  the  various  positions. 

PART  I. 

Position  of  Parturient  Women  among  peoples  whose  parturition  is 
governed  by  instinct  and  not  by  modern  obstetrics — Savages  of 
to-day  and  civilized  races  of  the  past. 

Perpendicular  or  Upright  Posture — Standing — common  among  Scla- 
vonians  and  Silesians — in  India  and  i^arts  of  Africa — Partially  sus- 
pended— Suspended. 

Inclined  Positions  —  Sitting  erect,  rare — Squatting  —  Indians  —  Tunis 
and  Persia — Kneeling — quite  common,  especially  yellow  and  red 
races — Kneeling  with  the  body  inclined  forward — Typical  descrip- 
tion of  labor  seen  among  Comauclie  Indians  by  Maj.  Forwood — 
Shelter  erected — Hot  douche — Curious  Japanese  custom — Knee-el- 
bow positions — In  difficult  cases  in  middle  ages — Kooteuais — Kneel- 
ing with  the  body  erect,  inclined  backwards  or  partially  suspended 
— Tartars — Supposed  to  have  existed  among  the  mound-builders  or 
pre-historic  people  of  America — Coyotero.  Apaches  in  difficult  la- 
bor— Cases  in  which  precise  description  is  lacking — "Why  did  not 
the  knees  of  my  mother  remain  stiff  and  I  strangle  in  birth?" — Semi- 
recumbent  —  Frequent  among  ancients  —  Sitting  semi-recumbent 
— Indians — Kaffirs — Arabs — Ancient  group  from  Cesnola  collection — 
Still  practiced  in  Cj'prus^ilodern  Cypriote  midwife's  chair — Sitting 
on  the  lap— Same  advocated  by  Savonarola,  1547 — Peculiar  couch 
for  same  position  in  Ohio — Virginia — The  Obstetric  Chnii" — Origin — 
History — Development — Described  in  the  "  generation  and  birth  of 
man  " — Rocking  chair  in  use  in  Syria — Semi-recumbent,  strictly  speak- 
ing— Canada — Japan — Penomonee  Indians — Ancient  Rome. 

Horizontal  or  Recumbent — Ordinary  dorsal  dec.ubitus — Care  among 
primitive  peoples — Lateral  decubitus — In  isolated  cases — Prone  upon 
stomach — Rare — Sometimes  in  difficult  labor. 

part  II. 

The  Position  of  Women  among  Civilizicd  Races  of  the  Present  Day  in 
THE  Agony  op  the  Expulsive  Pains — Serai-recumbent  position  usual- 
ly taken. 

Resume  and  Conclusions — Instinct  governs  position  of  savages — Comfort 
and  modesty  govern  modern  obstetrics — Positions  vary  in  different 
stages  of  labor — Strikhig  positions  mostly  in  last  stage — INIassage  in  dif- 
ficult cases — We  should  give  patients  greater  liberty  in  labor — Dorsal 
decubitus  undesirable  as  a  rule — An  inclined  position  should  be  resorted 
to — Semi-recumbent  best. 


CONTENTS. 

CHAPTER  III. 


THE  THIRD  STAGE  OF  LABOR. 

Tkeatmext  of  Simple  Cases — More  natural  among  primitive  people — Mostly 
the  placenta  is  delivered  in  the  same  position  in  which  the  child  was  ex- 
pelled— Manual  expression — Kneeding  of  the  abdomen  very  common — 
Diaphragm  often  made  use  of — Traction  on  the  cord  not  as  common  as 
among  civilized  people — Less  often  is  the  placenta  delivered  in  a  posi- 
tion different  from  the  one  occupied  during  the  expulsion  of  the  child — 
The  motion,  or  the  standing  position  assumed,  supposed  to  further  ex- 
pulsion. 

Management  of  Difficult  and  Complicated  Cases — Forcible  expulsion 
b}^  external  pressure— Methods  of  cutting  and  tying  the  cord — Burial  of 
after-birtli  and  other  superstitions — Importance  of  skilled  management 
in  the  third  stage — Vis  a  Tergo  practiced  by  primitive  people — a  posi- 
tion only  recently  obtained  by  scientific  Midwifery. 


CHAPTER  IV. 


MASSAGE  AND  EXPRESSION. 

HiSTOKY  OP  Massage. — Spoken  of  in  history  and  poetry— Advocated  by 
Hippocrates — Popular  in  Sweden — Manipulations  numerous  and  well-de- 
fined— Stimulation  of  muscle  and  nerve  one  of  its  most  important  physi- 
ological effects. 

External  Manipulations  Long  Used  in  OssTETmc  Practice. — The  only 
means  a  crude  people  have  of  overcoming  difficulties  in  labor — Resorted 
to  in  all  possible  positions — Shampou — Cong-Fou — Ambouk. 

External  Manipulations  Now  in  Use. — Numerous — 1.  Simple  compression 
and  expression — By  the  arms  of  an  assistant — Kneeling  or  sitting 
behind  the  patient  the  assistant  uses  his  arms  as  a  compressor — See  Front- 
ispiece— A  bandage  passed  around  the  body  is  tightened  by  an  assistant— 
The  abdomen  is  drawn  across  a  rope  or  pole — The  abdomen  stripped  down 
by  arms  of  assistants— Expression  by  means  of  the  feet — Pressure  upon  a 
staff — Lying  upon  the  stomach.  2.  Massage— A  more  complicated  manip- 
ulation— The  patient  shaken  upon  a  blanket,  in  the  air— Permanent  pres- 
sure— The  uses  of  massage  and  expression — In  pregnancy — To  correct 
malpositions — To  produce  abortion — In  labor — Even  in  simple  cases— 
To  change  position  of  child — To  hasten  expulsion  of  placenta — In  child- 
bed rare— The  development  of  external  manipulations  in  recent  obstetric 
practice — Wiegaud,  1 812— Wright — Brax.ton  Hicks — Credci — Literature. 


CONTENTS. 

CHAPTER  Y. 


CHAEACTEKISTIC  LABOR  SCENES  AMONG   THE   YELLOW,   BLACK, 
AND  RED  RACES. 


Yellow  Racks. — Japanese  use  binder  during  pregnancy — Scliool  for  mid- 
wives — Kneel  iu  labor — Variance  of  customs  when  the  child  is  male  or 
female — Value  of  the  remnant  of  the  cord.  Ainos — roomy  pelvis — Prep- 
arations for  labor — Deliver)' — Girdle  applied  after  expulsion  of  child — 
hemorrhages  not  rare  from  pulliug  out  placenta.  Kalmucks — Squat — 
Eiring  of  gun  to  hasten  expulsion — Mother  unclean  for  three  weeks — 
Burial  of  placenta — Nursing  up  to  future  pregnancy. 

Black  Races. — Loango  Negroes  above  average — Women  considered  unclean 
during  menstruation  and  childbed — Loango  women  short-breasted — A 
moral  people — "  Ndodschi" — Parturition  easy — Patient  stands,  leaning 
against  a  wall,  or  kneels — Prone  upon  stomach  in  difficult  cases — Gag  in 
mouth  and  nose  to  force  expulsion — Superstition  as  to  placenta  and  cord 
— Frequent  bathing — Massage — Sexual  intercourse — Love  of  the  Loango 
mother  for  her  child — Baptism. 

The  Red  Races. — Kneeling  postui-e  most  common.  Indians  of  the  Pacific 
Coast — Move  about  in  first  stage — Compression  of  abdomen — Semi-re- 
cumbent, but  kneeling  In  difficult  cases — Uterus  assisted  in  imme- 
diately expelling  the  placenta— Some  walk  about  after  delivery — Com- 
press abdomen — Others  are  wrapped  in  blankets — Placed  by  fire — No 
puerperal  diseases.  Eastern  Tribes — Peculiar  shelter  constructed  by 
Comanches — Disgusted  at  es  amination — Ceremonies  aiding  labor — Effect 
of  fear — Cord  tied  one  foot  from  body — Peculiar  method  of  paying  the 
doctor — Superstitions  as  to  woman's  functions — Mother  and  father  re- 
frain from  meat — Description  of  last  three  illustrations. 


PREFACE  TO  THE  SECOND  EDITION, 


It  was  with  many  misgivings  that  i  first  offered  this  little 
volume  to  the  profession  in  June,  1882. 

The  kindly  criticisms  it  received  from  the  medical  press 
at  home  and  abroad  have  been  a  pleasant  surprise,  and, 
together  with  the  rapid  exhausting  of  the  first  edition, 
have  assured  me  of  the  favorable  reception  which  has  been 
accorded  this  rather  novel  research,  notwithstanding  the 
unfortunate  arrangement  of  the  material.  An  equally 
agreeable  and  satisfactory  proof  of  the  interest  which  the 
profession  has  taken  in  the  anthropological  aspect  of  mid- 
wifery, to  which  I  have  endeavored  to  direct  attention  in 
the  present  volume,  will  be  found  in  the  references  to 
obstetric  practice  among  various  races,  as  well  as  the 
elaborate  articles  upon  the  subject  which  have  appeared 
in  the  Medical  Journals  of  Europe  and  America  since  the 
publication  of  Labor  Among  Primitive  Peoples,  and  have 
become  quite  frequent  of  late. 

The  call  for  a  second  edition  has  afforded  me  an  oppor- 
tunity of  adding  much  valuable  and  interesting  informa- 
tion, which  I  have  received  during  the  last  six  months, 
and  of  correcting  the  arrangement  of  the  book,  so  that  the 
chapters  now  follow  in  natural  order. 

Much  time  and  labor  has  been  expended  upon  this 
edition  by  the  publishers,  Messrs.  Chambers  &  Co.,  and  it 
is  owing  to  their  energy  and  interest  that  I  am  enabled 
to  present  this  second  thoroughly  revised,  completely 
changed,  and  very  much  enlarged  edition  to  my  profes- 
sional brethren,  who  so  generously  overlooked  the  faults 
of  the  first. 


xiv  FREFA  CE. 

At  the  same  time  a  German  edition,  prepared  by  Prof, 
Hennig,  of  Leipzig,  will  appear  in  Vienna,  with  some  ad- 
ditions upon  the  pelvic  measurements  among  various  races 
and  their  importance  in  relation  to  the  parturient  act — a 
subject  upon  which  Professor  Hennig  is  an  acknowledged 
authority — and  I  had  hoped  that  it  would  be  possible  to 
incorporate  this  valuable  chapter  in  the  present  volume ; 
but  as  the  publishers  will  delay  no  longer,  I  must  send 
forth  this  second  edition  as  ifc  is,  with  the  wish  that  it 

MAY   ^B   AS    WELL    EECEIVED    AS   ITS    PREDECESSOR! 

G.  J.  E. 
3003  Locust  Street, 
Feb.  5,  1883. 


PREFACE  TO  FIRST  EDITION. 


In  offering  these  pages  to  tlie  Profession,  I  must  ask 
their  indulgence,  as  well  as  a  kindly  consideration,  for  a 
work  which  is  novel  in  kind ;  and  lest  the  gentle  critic, 
with  a  keen  pen,  should  in  his  friendly  way  point  out  to 
the  reader  the  palpable  faults  of  my  little  Ibook,  I  will 
at  once  crave  his  indulgence  for  presenting  a  subject 
ethnological — rather  than  Tnedlcal — in  character,  and  for  giv- 
ing the  work  to  the  public  with  the  present  faulty  arrange- 
ment of  Chapters. 

In  the  Introduction  to  Chapter  I.,  I  will  tell  how  an  ex- 
amination of  that  ancient  Peruvian  Funeral  Urn  incited 
me  to  the  study  of  the  customs  of  Primitive  Peoples — at 
first  only  of  the  position  occupied  by  "Women  in  Labor, 
the  subject  which  would,  perhaps,  most  naturally  arouse 
curiosity  and  stimulate  research  on  account  of  the  pecu- 
liar and  very  striking  facts  presented. 

So  many  other  strange  and  interesting,  mostly  unknown, 
data  accumulated  from  the  responses  which  my  enquiries 
received  from  all  quarters  of  tho  Globe  and  from  the  peru- 
sal of  the  many  volumes,  Medical,  Historical  and  Ethno- 
logical, for  which  I  had  ransacked  the  libraries  East  and 
West,  that  one  subject  after  the  other  presented  itself,  and 
in  my  enthusiasm  I  developed  one  after  the  other.  The 
result  was  a  series  of  articles  upon  subjects  ethnological, 
as  I  have  said,  rather  than  medical,  which  have  been  gath- 
ered in  this  little  book. 

Yirchow,  that  leader  and  master  mind,  was  one  of  the 
first,  certainly  the  first  of  medical  men,  to  develop  the 
science  of  ethnology,  although  more  with  reference  to  cra- 
niology  and  sociology,  yet  thus  it  has  become  an  ally,  a 


x\i  PREFACE. 

sister  science  to  medicine ;  why  should  we  not  take  one 
step  farther?  Why  should  ethnology  not  prove  an  aid  in 
the  development  of  other  Ibranches  of  medicine  as  well? 
Although  a  new  departure,  I  may  say  that  Ethnology  will 
add  greatly  to  the  study  of  obstetric  science  and  its  thor- 
ough understanding;  it  will  "be  a  guide  to  the  study  of 
Midwifery,  as  Comparative  Anatomy  is  to  that  of  Anatomy, 
and  moreover  a  necessity  to  its  complete  understanding. 

I  liave  presented  the  result  of  my  investigations  by  rea- 
son of  their  intense  interest  to  me,  and  because  a  compari- 
son of  the  crude  methods  of  Primitive  Peoples  and  Peoples 
of  former  civilizations  with  the  teachings  of  scientific 
obstetrics  of  to-day  are  amusing  and  interesting,  but  above 
all  instructive  and  important.  If  I  have  erred,  it  is  my  en- 
thusiasm which  has  carried  me  away. 

So  much  for  the  Subject,  now  for  the  Arrangement  of  the 
work.  The  chapters  follow,  not  in  logical  order,  but  in 
the  succession  in  which  chance  presented  the  material,  and 
the  order  in  which  the  articles  appeared — the  first  one  on 
Posture,  in  the  Transactions  of  the  American  Gynecologi- 
cal Society  of  1880 ;  the  second,  third  and  fourth  in  the 
American  Journal  of  Obstetrics  from  April,  1881,  to  July, 
1882  ;  and  the  fifth  in  the  Conrier  of  Medicine  of  St.  Louis 
for  March  and  May,  1882. 

In  the  arrangement  of  this  volume  circumstances  neces- 
sitated the  faulty  order,  wliicli  the  reader  cannot  oTierlook, 
yet  will,  I  trust,  generously  ijardon. 

Let  us  glance  hastily  over  some  of  the  more  striking 
features  here  presented :  Is  it  not  a  matter  of  interest  to 
see  how  the  moon.,  the  world  over,  is  connected  with  the 
menstruation  of  woman  ;  how,  in  France,  in  past  centuries 
our  ^^montJily  flow,"  the  German  "  JioTia^Z/c/^d  Reinigung," 
was  called  the  "  tribute  which  woman  renders  the  moonf 
the  Indian  speaks  of  a  woman  in  this  state  as  having 
"  moon  in  the  ass" — so  the  world  over.  Again,  the  idea  of 
cleansing.,  purifying,  is  expressed  in  the  German  "monat- 
liclie  lieinigung ^''  whilst  the  natives  of  Africa,  of  India, 
and  of  our  Western  territories,  still  consider  the  female  at 


PREFACE.  xvii 

that  time  as  unclean.,  and  isolate  her,  keep  her  away, 
especially  from  men,  in  a  separate  hut ;  and  that  she  may 
be  well  known  to  all,  when  she  mingles  with  others,  she  is 
obliged  to  wear  certain  well-marked  colors  during  the  con- 
tinuance of  the  period.  This  is  more  particularly  the  case 
among  the  numerous,  still  natural  peojDle  of  Asia,  as  it 
was  my  good  fortune  to  observe  myself  among  the  Nauch 
girls  while  traveling  in  this  country.  This  idea  of  unclean- 
liness  clings  equally  to  the  puerpera  during  the  continu- 
ance of  the  lochial  flow,  and,  remarkable  enough,  in  a  dif- 
ferent degree  to  the  lochia  riibra  and  alba. 

How  reasonable  !  The  menstruating  woman  is  confined 
in  a  separate  hut,  is  isolated,  does  no  work,  rests,  is  not 
exposed  to  cold  or  exertion,  and  thus  escapes  the  numer- 
ous uterine  troubles  which  befall  the  civilized  female  by 
reason  of  ignorant  or  careless  exposure  during  this  period 
of  increased  sensitiveness. 

The  parturient  is  confined  in  an  isolated  shelter,  which 
is  destroyed  when  labor  is  over,  or  in  a  hut  or  house  kept 
for  the  purpose,  in  a  particular  room.  Whatever  the  idea 
may  be,  the  result  is  certainly  to  prevent  infection — to  pre- 
vent puerperal  fever. 

The  Japanese  in  pregnancy  already  endeavor  to  prevent 
malpositions  by  external  manipulations  of  the  abdomen ; 
others  bind  the  abdomen  in  pregnancy.  How  sensible 
their  laws  governing  coition  during  pregnancy  !  we  can  cer- 
tainly^, with  advantage,  study  their  reasonable,  though 
instinctive  and  crude  customs  ! 

A  vast  and  important  fund  of  knowledge  may  be  de- 
rived from  a  study  of  the  various  positions  occupied  by 
women  of  different  peoples  in  their  labors.  According  to 
their  build,  to  the  shaioe  of  the  pelvis,  they  stand,  squat, 
kneel  or  lie  upon  the  belly  ;  so  also  they  vary  their  posi- 
tion in  various  stages  of  labor  according  to  the  position 
of  the  child's  head  in  the  pelvis.  Does  the  great  number 
of  natural  labors  resulting  not  point  to  a  law  greatly  at 
variance  with  the  teachings  of  modern  obstetrics  ?  Is  it 
not  evident  that  difierent  positions  should  be  given  in  dif- 


•^^"^  PREFACE. 

ferent  stages  of  labor,  and  in  its  varions  periods  ?  But  it 
will  necessitate  a  great  advance  in  obstetric  science  and 
much  research  to  determine  the  underlying  law.  Here, 
however,  we  have  the  facts. 

Although  primitive  peoples,  like  modern  obstetricians, 
vary  in  the  method  of  managing  the  third  stage  of  labor, 
manual  expression  is  almost  universally  resorted  to ;  the 
"Gis  a  tergo  is  acknowledged,  and  the  cord  rarely  serves  the 
injurious  purpose  to  which  most  modern  midwives  put  it. 
As  I  say  at  the  conclusion  of  chapter  III.,  the  North  Ameri- 
can Indians  and  the  African  Negroes,  undoubtedly  other 
tribes  also,  have  for  ages  followed  a  practice  so  perfect 
that  only  within  the  last  few  years  the  most  alert  of  our 
obstetricians  are  in  a  position  to  compare  with  them.  This 
fact  has  been  noticed  by  Dr.  C.  M.  Fenn,  of  San  Diego, 
California,  who  has  an  article  in  the  American  Journal  of 
Obstetrics' for  1S81  contemptuously  termed  the  "Practice 
and  Perils  of  Belly-squeezing  in  Mexican  Obstetrics,"  in 
which  he  tells  of  their  rude  ways,  and  at  the  close  is 
greatly  astonished  that  no  harm  is  done,  but  that  the 
women  do  well.  He  says  :  "  Convalesence  has  been  rapid 
and  normal  in  all  of  the  cases  which  have  come  under  my 
observation,  and  sufficient  time  has  elapsed  (more  than  six 
months  since  the  last  case)  for  the  development  of  uterine 
ailments.  More  than  this,  in  a  not  limited  experience 
among  these  people,  I  have  met  with  but  two  or  three 
cases  of  uterine  disease,  and  am  prepared  to  assert  that 
metritis,  oophoritis,  and  kindred  maladies,  are  exception- 
ally rare." 

How  grand  a  proof  from  unwilling  source  to  the  ef- 
ciency  of  this  method  which  scientific  obstetricians  are 
just  beginning  to  adopt,  in  fact,  have  just  discovered. 
Massage  and  expression,  external  manij)ulations,  have 
reached  such  a  perfection  as  uncultured  minds  can  give  : 
we  can  learn  much  from  the  customs  of  these  people,  and 
if  developed  by  science,  sifted  and  classified,  great  good 
will  result. 

The  savage  mother,    the    Negress,   the  Australian  or 


PBEFACE.  xix 

Indian,  still  governed  by  lier  instinct,  is  far  in  advance  of 
the  ordinary  woman  of  our  civilization.  She  bathes  herself 
and  her  offspring  at  once,  she  keeps  herself  clean.  "Won- 
derful to  say,  the  same  difference  exists  among  the  various 
races  of  Primitive  People  in  their  customs  as  to  nursing  as 
we  find  among  the  physicians  of  to-day.  Some  few  put 
the  child  to  the  breast  at  once,  most  wait  for  two  or  three 
days,  and  of  milk  fever  they  seem  to  know  nothing  ;  the 
time  of  nursing  also  varies  greatly,  usually  from  one  to 
two  years.  Their  methods  of  weaning  are  like  our  own, 
in  the  application  of  asafoetida  to  the  nipple,  or  of 
charcoal,  to  disgust  the  child  ;  even  the  castor-bean  plant 
has  been  used  as  a  lactagogue,  the  mother  washing  her 
breast  with  its  juice. 

I  have  but  briefly  referred  to  some  of  the  interesting 
points  to  show  how  similar  the  obstetric  practices  of  Prim- 
itive Peoples,  past  and  present,  are  to  our  own,  and  yet 
although  crude  how  far  in  advance  in  many  points — in  all 
such  in  which  simpler  means,  the  hands  and  external  manip- 
ulations will  answer.  The  womb  they  never  enter,  instru- 
ments they  have  none,  but  as  far  as  general  treatment  and 
external  manipulations  will  reach  their  management  is 
wonderful,  and  we  will  find  much  to  study,  to  imitate,  and 
to  develop. 

The  great  field  opened  to  us  is  the  study  of  the  position 
to  be  occupied  by  woman  in  labor,  as  determined  by  the 
configuration  of  her  pelvis  and  the  position  of  the  child's 
head.  Primitive  peoples  have  solved  this  problem  by  virtue 
of  their  instinct ;  now  it  remains  for  the  science  of  civilized 
races  to  determine  the  when  and  wherefore. 

I  trust  that  what  I  have  said  may  induce  the  reader  to 
peruse  these  pages  with  a  certain  interest  which  will  lead 
him  to  pardon  or  forget  their  faulty  arrangement. 

G.  J.  E. 
3003  Locust  Street^ 

St.  Louis,  June  I,  18S2. 


CHAPTER  I. 


PREGNANCY,  PARTURITION  AND  CHILDBED. 


As  it  shall  be  my  endeavor  to  unravel  the  mysteries  of  the 
obstetric  art  among  primitive  peoples,  to  describe  the  peculiar 
features  in  the  obstetric  practice  of  the  various  savage  races 
during  every  stage  of  labor,  I  will  now,  in  this  first  chapter, 
for  the  better  understanding  of  these  details,  completely  de- 
scribe that  most  interesting  period  in  the  life  of  woman,  so 
important,  socially  as  well  as  professionally — the  time  of 
pregnancy,  labor  and  childbed. 

"We  will  find  among  the  natural  habits  of  primitive  people 
many  points  of  resemblance  to  the  customs  of  our  more  advanced 
civilization.  In  their  views,  in  their  methods  of  treatment  of 
the  parturient,  we  see  rudely  depicted  the  lying-in  chamber  of 
to-day ;  indeed,  many  a  labor  in  the  cellar  or  the  attic  of  a 
crowded  city,  or  in  the  log  cabin  of  a  secluded  country  dis 
trict,  differs  but  little  from  that  which  we  will  find  in  the  tepet 
of  the  Indian  or  the  hut  of  the  Negro  ;  in  fact,  It  is  here  that 
we  often  see  customs  which  are  rudely  indicative  of  some  of 
the  very  best  of  our  modern  improvements  upon  which  obste- 
tricians greatly  pride  themselves ;  observation  has  taught  these 
children  of  nature  many  a  lesson  of  which,  in  their  natural 
shrewdness,  they  have  profited. 


PKEGNANCY. 


We  can  trace  a  certain  resemblance  throughout;  thus  a 
great  deal  of  interest,  and  I  may  say  of  importance,  attaches 
among  many  tribes  to  the  pregnant  state,  be  it  in  the  jungles 
of  India,  in  the  wilds  of  Africa,  or  upon  our  own  prairies. 
It  is  to  the  woman  an  eventful  period  of  her  life,  and  is  appreci- 
ated as  such  by  her  tribe  as  important,  not  only  for  herself 
but  for  all  her  people.  The  Andamanese,  for  instance,  are 
extremely  proud  of  their  condition,  which  in  their  native  state 


2  LABOB:  AN  ETHNOLOGICAL  STUDY. 

is  of  course  very  evident  to  any  beholder,  and  if  a  stranger  shows 
himself  in  their  villages,  they  point  with  a  grunt  of  satisfac- 
tion to  the  distended  abdomen.  Among  the  Hebrews  and 
other  people  of  ancient  times,  sterility  was  a  disgrace  (Gen. 
xi.  30 ;  Exod.  xxiii.  26 ;  Kotelman),  and  the  mother  of  many 
children  was  a  greatly  envied  woman.  Conception  was  fa- 
vored, although  no  laws  existed  upon  the  subject,  by  coitus 
soon  after  the  cessation  of  the  menses,  the  act  being  forbidden 
only  during  religious  service  and  upon  the  days  of  the  high 
feasts. 

Abortions  as  a  rule  are  not  numerous;  the  African  tribes  in 
the  main  are  fond  of  children,  and  hence  rarely  destroy  them. 
Among  some  of  our  Indians,  especially  those  in  closer  contact 
with  civilization,  laxer  morals  prevail,  and  we  find  abortion 
quite  frequent ;  some  tribes  have  a  reason  for  it,  on  account  of 
the  difficult  labor  which  endangers  the  life  of  the  woman  bear- 
ing a  half-breed  child,  which  is  usually  so  large  as  to  make  its 
passage  through  the  pelvis  of  the  Indian  mother  almost  an 
impossibility. 

In  old  Calabar,  medicines  are  regularly  given  at  the  third 
month  to  prove  the  value  of  the  conception.  Three  kinds  of 
conception  are  deemed  disastrous:  first,  if  resulting  in  twins; 
second,  in  an  embryo  which  dies  in  utero ;  third,  in  a  child 
which  dies  soon  after  1  irth  ;  and  it  is  to  avoid  the  further  devel- 
opment of  such  products  that  the  medicines  are  given;  the 
idea  being  that,  if  the  pregnancy  stands  the  test  of  these  medi- 
cines, it  is  strong  and  healthy.  In  case  the  ovum  is  expelled, 
it  must  have  been  one  of  these  undesirable  cases  of  which  no 
good  could  have  come.  The  medicines  are  first  given  by  the 
mouth  and  the  rectum,  then  per  vaginarn,  and  applied  directly 
to  the  OS  uteri,  provided  that  a  bloody  discharge  follows  the 
first  doses.  For  this  purpose  they  use  one  of  three  herbs  :  a 
Leguminosa,  an  Euphorbia,  or  an  Amomum.  The  stalk  of  the 
Euphorbia  with  its  exuding  juice  is  pushed  up  into  the  vagina; 
on  the  same  part  of  the  leguminous  plant  is  placed  some 
Guinea  pepper,  chewed  into  a  mass  with  saliva :  in  a  few  days 
the  abortion  takes  place.  The  measures  employed  are  fre- 
quently too  severe,  as  constitutional  disturbance,  and  some- 
times death  follows.  Among  Indians  and  Negroes  abortion  is 
now  and  then  practised  if  a  suckling  mother  conceives,  as  they 


PBEGNANCY,  PARTURITION  AND  CHILDBED.  3 

reason  that  the  living  child  is  the  more  important  and  would 
be  harmed  by  the  drain  which  the  new  pregnancy  necessarily 
exerts  on  the  strength  of  the  mother. 

The  seventh  month  is  not  unfreqnently  regarded  as  danger- 
ous, as  many  abortions  then  occur.  For  this  reason,  in  Old  Cal- 
abar, the  patient  is  generally  sent  away,  as  pregnancy  advances, 
to  a  country  place  where  she  can  live  quietly  and  free  from  the 
excitement  and  bustle  of  the  town  ;  and  above  all  where  she  can 
be  out  of  the  way  of  witch-craft.  A  great  many  superstitions 
exist  among  all  peoples  in  reference  to  this  important  epoch, 
more  especially  among  some  tribes  of  the  Finns,  for  instance 
the  Esthonians  ;  one  of  the  most  amusing  of  these  ideas  is  the 
weekly  changiug  of  shoes  customary  among  pregnant  women, 
which  is  done  in  order  to  lead  the  devil  off  the  track,  who  is 
supposed  to  follow  them  constantly  that  he  may  pounce  upon 
the  new-born  at  the  earliest  moment. 

The  same  great  wish  prevails  for  a  boy  among  savage  races 
as  among  our  own  people,  even  to  a  much  greater  extent,  and 
naturally  so,  as  in  the  male  child  the  warrior  of  the  future 
is  looked  for ;  our  own  Indians,  as  well  as  the  Negroes  of 
Africa,  have  numerous  ceremonies  by  the  faithful  observance 
of  which  they  hope  to  produce  the  desired  sex ;  but,  however 
interesting  they  may  be,  we  cannot  now  enter  upon  their 
further  consideration. 

Here  and  there  signs  of  pregnancy  are  carefully  observed : 
in  Old  Calabar,  as  well  as  in  the  interior  of  Africa,  pregnancy 
is  counted  from  the  suspension  of  the  menses,  and  the  time  is 
reckoned  by  lunar  months ;  among  Sclavonians  the  appearance 
of  freckles  is  looked  upon  as  a  safe  sign  of  pregnancy. 

The  care  which  is  taken  of  pregnant  women  depends,  of 
course,  greatly  upon  their  surroundings  and  increases  with  the 
civilization  of  the  people.  "We  see  this  best  illustrated  among 
the  North  American  Indians  :  very  little  or  no  distinction  is 
made  among  the  nomadic  tribes,  but  as  soon  as  we  come  to  a 
more  sedentary  population,  such  as  the  Pueblos,  or  the  natives 
of  Mexico,  we  see  that  they  become  more  considerate.  No 
over-exercise  is  permitted,  warm  baths  are  frequently  taken, 
and  the  abdomen  is  regularly  kneaded  in  order  to  correct 
the  position  of  the  child.  This  is  also  the  case  in 
Japan,  and   whether  the   diagnosis  of  a  malposition  is  made 


4  LABOB:  AN  ETHNOLOGICAL  STUDY. 

in  the  early  stages  of  pregnancy  or  not,  it  is  a  fact  that 
the  abdomen  is  subjected  to  this  treatment,  and,  nnques- 
tionably,  in  many  instances,  the  position  is  thus  recti- 
fied. This  is  done  by  massage  and  manipulation  among  these 
somewhat  more  advanced  people,  whilst  the  nomadic  Indians 
of  the  prairie  accomplish  the  same  end  by  hard  work  and 
horse-back  riding.  The  great  danger  in  labor,  and  to  the 
savage  woman  the  one  great  danger,  is  a  transverse  position  of 
the  child.  This  they  must  use  every  means  to  avoid,  as  with 
them  death  is  certain  if  labor  is  inaugurated  with  the  child  in 
such  a  position. 

I  have  already  described  in  full  the  method  of  rectifying 
malpositions  as  practised  in  Japan,  in  my  paper  on  "  Posture," 
and  will  only  say  that  the  process,  mainly  massage,  is  repeated 
every  morning  after  the  fifth  month,  the  practitioner  making 
the  patient  stand  up  and  put  her  arms  around  his  neck.  The 
Andamanese  and  the  Wakamba  of  Africa,  many  of  the  no- 
madic Indians,  and  undoubtedly  almost  all  of  the  women  of 
savage  tribes  work  up  to  the  very  hour  of  labor.  Rigby  states 
that  he  finds  the  easiest  labors,  and  the  best  results,  when  the 
women  work  or  continue  their  wonted  employments  until 
labor  pains  are  upon  them;  it  always  goes  worse  with  those 
who  idle  beforehand,  with  the  view  of  saving  themselves  and 
making  labor  easier.  This  statement  we  find  constantly  veri- 
fied in  our  ordinary  practice ;  we  know  that  the  working 
women — and  we  have  many  such — who  continue  their  wonted 
employments  until  tlie  very  moment  of  delivery,  have  the  easi- 
est labor.  It  is  the  lady  who  is  so  conservative  of  her  strength 
and  anxious  to  do  everything  in  her  power  to  promote  her 
health  and  the  welfare  of  her  offspring,  who  suffers  most.  At 
all  events  we  shall  not  fear  evil,  and  the  pregnant  woman  will 
fare  best  in  the  coming  labor,  if  she  will  continue  as  long  as 
possible  in  the  exercise  of  her  usual  duties,  whatever  they  may  be. 

In  Mexico,  as  the  old  histories  tell  us,  the  pregnant  woman 
was  forbidden  to  yield  too  freely  to  the  desires  of  the  husband, 
although  coitus  was  indeed  ordered  to  a  certain  extent,  so 
that  the  offspring  might  not  prove  weakly.  In  Loango 
coitus  is  not  forbidden.  Some  regulations  with  regard  to  the 
act  exist  among  other  tribes,  and  the  too  free  exercise  of 
matrimonial  rights  is  often  cautioned  against. 


PREGNANCY,  PABTUBITION  AND  CHILDBED.  5 

The  well  regulated  government  of  old  Mexico  was  careful  of 
pregnant  woman  in  many  ways ;  the  Burmese  women  wear 
a  tight  bandage  about  the  abdomen  after  the  seventh  month  of 
pregnancy,  to  prevent  the  ascent  of  the  uterus,  under  the  idea 
that  the  higher  the  child  ascends  in  the  abdomen  the  farther  it 
will  have  to  travel  in  labor  when  it  descends,  and  hence  the 
more  painful  the  delivery  will  be.  In  Japan,  the  midwife  is 
consulted  at  about  the  fifth  month,  and  she  then  binds  the  ab- 
domen with  a  cloth  which  is  not  removed  until  labor  bee-ins, 
it  being  kept  there  so  that  the  child  should  not  grow  too  large. 
It  is  the  same  procedure  which  is  followed  in  India,  althouo-h 
the  underlying  idea  is  different,  and  three  times  a  month  the 
abdomen  is  rubbed.  The  Nayer  women  bathe  a  great  deal 
during  pregnancy,  taking  good  care  of  body  and  soul.  In  fact, 
the  frequent  bathing  of  pregnant  women  is  common  also  to  all 
the  higher  castes  of  India.  The  Nayer  perform  a  ceremony 
during  the  first  month  of  pregnancy,  but  as  it  so  frequently 
happens  that  a  woman  erroneously  considered  herself  in  that 
condition,  this  ceremony  for  the  preservation  of  tlie  pregnant 
woman  against  the  wiles  of  the  devil  is  usually  delayed  until 
the  fifth  or  even  the  seventh  month  ;  and  upon  the  following 
morning  she  very  properly  drinks  the  juice  of  tamarind  leaves 
mixed  with  water. 

Here  and  there  some  preparation  is  made  to  ease  the  inten- 
sity of  the  coming  labor  pains.  Upon  the  isle  of  Jap,  in  West 
Mikronesia,  they  begin  to  dilate  the  os  uteri  at  least  one 
month  before  delivery  is  expected ;  the  leaves  of  a  certain 
plant,  tightly  rolled,  are  inserted  into  the  os,  moistened  by  the 
uterine  secretion  they  distend,  and  when  fully  dilated  a  thicker 
roll  is  introduced.  They  are  to  act  upon  the  principle  of  la- 
minaria  or  sponge  tent,  slowly  dilating  the  mouth  of  the  womb 
and  making  labor  more  speedy  and  less  painful. 

A  very  pretty  idea  exists  among  the  Pahutes  with  regard  to 
the  coming  of  the  child  ;  they  recognize  the  approaching  time 
for  the  addition  to  their  household  and  tribe,  and  seek  to  make 
preparation  for  the  advent  of  the  young  stranger ;  that  is  to 
say,  they  endeavor  to  make  his  journey  easy  and  expeditious 
with  the  least  possible  pain  to  the  mother.  Their  ideas  are 
crude  and  fallacious,  yet  to  them  sufficiently  convincing  to  be 
universally  practised.     They  consider  the  sojourn  of  the  off- 


Q  LAB  OB:  AN  ETHNOLOGICAL  STUDY. 

spring  in  utero  as  a  voluntary  matter,  and  after  a  given  length 
of  time,  say  nine  moons  or  the  lapse  of  certain  seasons  of  the 
year,  the  child  is  to  be  starved  out  of  its  maternal  quarters  as 
a  wood-chuck  or  other  game  is  to  be  forced  out  of  its  hiding 
place ;  hence,  for  weeks  before  the  expected  event  a  fast  begins 
with  the  mother,  which  becomes  almost  absolute  as  the  time 
'approaches,  so  that  by  the  end  of  the  allotted  period  of  gesta- 
tion the  fetus  will  not  only  be  ready,  but  anxious  to  come  to 
the  world  in  order  to  reach  the  supply  of  milk  which  the 
mother  has  now  in  waiting  for  the  child  starved  in  the  womb. 
They  of  course  act  on  the  presumption  that  the  child  is  nour- 
ished by  ingestion  from  the  mother.  But  another  reason  or 
object  they  have  in  view  is,  that  this  treatment,  this  fasting, 
reduces  the  maternal  tissue  over  the  genital  organs  and  thus 
opens  a  wider  door  for  the  exit  of  the  fetus.  After  this  prepa- 
ration, when  labor  has  actually  begun,  they  regard  its  phenom- 
ena as  due  to  voluntary  efforts  on  the  part  of  the  child  to 
leave  its  inhospitable  quarters  for  exterior  life,  and  everything 
in  their  rude  philosophy  is  done  to  facilitate  and  help  the  little 
fellow  along  on  his  journey. 

Similar  ideas  prevail  among  other  peoples  as  well,  and  it 
seems  innate  to  natural  man  to  accord  a  certain  independence 
to  the  fetus  while  in  the  womb  of  the  mother,  and  that 
according  to  his  own  will  he  takes  his  position  in  utero  and 
leaves  it  when  he  chooses. 

The  Chinese  believe  that  pregnancy  can  last  two  or  three 
years,  because  the  child  does  not  wish  to  leave  the  womb  ; 
and  even  in  a  legal  Mussulman  treatise  it  is  stated  that  the 
maximum  term  of  gestation  may  attain  four  or  five  years. 
Like  the  Pahutes,  the  Chinese  lay  great  strees  upon  the 
voluntary  action  of  the  child  in  his  departure  from  the 
womb  ;  thus  the  parturient  is  advised  to  remain  quiet, 
especially  not  to  lie  upon  her  belly  before  the  head  presses 
upon  the  perineum  ;  the  belief  being  that  the  fetus  executes 
every  movement  voluntarily  and  by  his  own  force,  and  every 
motion  of  the  mother,  especially  every  compression,  inter- 
feres. A  foot  presentation  is  attributed  to  the  fact  that  the 
mother  has  turned  upon  her  belly  before  the  child  com- 
menced to  make  his  escape  ;  shoulder  and  other  presenta- 


LABOR:  AN  ETHNOLOGICAL  STUDY.  7 

tions,  to  the  fact  that  the  woman  has  turned  upon  her  belly 
during  the  escape. 

Even  in  France  the  time  is  not  long  passed  when  the  vol- 
untary motions  of  the  fetus  were  spoken  of,  and  when  the 
cause  of  labor  pains  and  expulsion  of  the  child  was  looked 
for  in  the  desire  of  the  fetus  to  change  its  condition  of  life. 
— (Corre.) 

Here  and  there  we  find  j)eculiar  customs  with  which  the  ' 
initiation  of  labor  is  greeted  ;  in  certain  Persian  villages  when 
the  woman  feels  the  first  pain  the  schoolmaster  is  asked  to 
excuse  the  scholars,  and   birds  held  in  cages  until  then  are 
freed — apparently  to  afibrd  quiet  to  the  sufferer. 

In  Morocco  five  little  boys  are  taken  from  school  and  are 
sent  to  run  through  the  streets  holding  a  cloth,  in  the  cor- 
ners of  which  four  eggs  are  attached,  and  upon  which  grown 
people  spit  and  throw  bottles  ;  finally  they  all  come  together 
with  kettles  and  pans,  and  make  a  terrible  noise  to  frighten 
the  devil  and  the  bad  spirits. — (Corre.) 

This  is  not  unlike  the  noise  the  Indian  medicine  man 
makes  in  his  tent,  or  the  negro  relatives  about  the  lying-in 
couch,  to  deaden  the  cries  of  the  patient. 

LABOR. 

Among  primitive  people,  still  natural  in  their  habits  and 
living  under  conditions  which  favor  the  healthy  development 
of  their  physical  organization,  labor  may  be  characterized 
as  short  and  easy,  accompanied  by  few  accidents  and  followed 
by  little  or  no  prostration  ;  the  squaw  of  the  Modoc  Indians 
— a  tribe  which  has  been  but  little  affected  by  the  advance  of 
civilization — suffers  but  an  hour  or  even  less  in  the  agony  of 
childbirth  ;  the  Sioux,  the  Kootenais,  and  the  Santees  are  some- 
what longer  in  labor,  not,  however,  over  two  or  three  hours; 
two  hours  being  about  the  average  time  among  the  North 
American  Indians.  The  period  of  suffering  is  very  jnuch  the 
same  among  the  natives  of  Africa  and  of  Southern  India,  the 
inhabitants  of  the  Antilles  and  the  Caribbees,  of  the  Andaman 
and  the  Australian  islands,  and  other  savage  people. 

"What  little  fear  exists  as  to  the  occurrence  of  this  event, 
which  is  so  much  dreaded  by  many  of  our  delicately  consti- 
tuted ladies,  may  be  judged  from  the  instances  of  speedy  and 
unexpected  delivery  so  often  related  by  those  in  contact  with 


8  LABOR:    AN  ETHNOLOGICAL    STUDY. 

the  Indians.  Dr.  Faulkner,  who  spent  sonae  years  among  the 
Sioux  tribes,  tells  me  that  he  has  known  a  squaw  to  go  for  a 
pack  of  wood  in  mid-winter,  have  a  child  while  gone,  wrap  it 
up,  place  it  on  the  wood  and  bring  both  to  the  lodge,  miles  dis- 
tant, without  injury.  Dr.  Choquette  says,  that  two  or  three 
years  ago,  an  Indian  party  of  Flat  Heads  and  Kootenais,  men, 
women,  and  children, set  out  for  a  hunting  trip;  on  a  severely 
cold  winter's  day,  one  of  the  women,  allowing  the  party  to 
proceed,  dismounted  from  her  horse,  spread  an  old  buffalo  robe 
upon  the  snow,  and  gave  birth  to  a  child  which  was  immedi- 
ately followed  by  the  placenta.  Having  attended  to  every- 
thing as  well  as  the  circumstances  permitted,  she  wrapped  up 
the  young  one  in  a  blanket,  mounted  her  horse,  and  overtook 
the  party  before  they  had  noticed  her  absence. 

It  seems  to  be  an  equally  easy  process  among  all  people  who 
live  in  a  perfectly  natural  state.  As  civilization  is  approached, 
the  time  of  labor  is  more  extended.  The  Mexican  Indians, 
half -civilized,  require  three  to  four  hours  for  delivery,  and  the 
same  is  true  for  all  such  tribes  as  are  in  closer  contact  with 
the  whites,  as  well  as  of  other  half-civilized  people.  Accidents 
rarely  occur ;  thus  a  physician  tells  me  that  during  a  residence 
of  eight  years  among  the  Canadian  Indians,  he  knew  of  no 
accident,  and  heard  of  no  death  in  childbed.  Another  pro- 
fessional brother,  who  lived  four  years  with  the  Oregon  Indians, 
was  not  aware  of  any  irregularity  occurring  in  that  time,  nor 
was  he  ever  called  upon  to  perform  a  more  serious  operation 
than  the  rupture  of  the  membranes. 

This  may  be  accounted  for  by  the  active  life  which  women 
lead  among  these  people ;  all  the  work  is  done  by  them,  so 
that  the  frame  and  the  muscular  system  are  developed,  and  the 
fetus,  by  constant  motion,  may  be  said  to  be  shaken  into  that 
position  in  which  it  best  adapts  itself  to  the  maternal  parts, 
into  the  long  diameter,  and  once  in  such  a  position  it  is  held 
there  by  the  firm  walls  of  the  maternal  abdomen,  and  the 
birth  becomes  easy.  Moreover,  they  do  not  marry  out  of  their 
own  tribe  or  race,  and  the  head  of  the  child  is  adapted  to  the 
pelvis  of  the  mother  through  which  it  is  to  pass. 

As  soon  as  there  is  any  deviation  from  these  natural  condi- 
tions, trouble  results.  Positive  statements  from  several  of  the 
Indian  tribes  indisputably  prove  the  truth  of  this  rule ;  thus 


PREGNANCY,  PARTURITION,  AND    CHILDBED.  9 

many  of  the  Uinpqiia  squaws  die  in  childbed  with  half-breed 
children,  whose  large-sized  heads  do  not  permit  of  their  exit. 
The  Unipqua  mother  will  be  easily  delivered  of  an  offspring 
from  an  Umpqua  father,  but  the  head  and  body  of  a  half- 
breed  child  is  apt  to  be  too  large  to  pass  through  her  pelvis. 
Unquestionably  this  is  the  case  also  among  other  savage  tribes. 

"We  can  then  readily  account  for  the  rapid  and  easy  delivery 
of  savage  women  who  live  in  a  natural  state,  and  the  rarity 
of  accidents  from  these  facts :  First,  they  marry  only  their 
kind,  and  thus  the  proportions  of  the  child  are  suited  to  the 
parts  of  the  mother;  secondly,  their  more  healthy  condition 
and  vigorous  frames ;  while,  thirdly,  from  the  active  life  they 
lead,  head  or  breech  presentations  result.  Should  this  latter 
fact  not  occur,  the  mother  is  generally  doomed,  or  at  best,  the 
labor  is  extremely  prolonged  and  fatiguing.  If  the  child  lie 
transversely  in  the  pelvis,  it  cannot  be  born,  and  death  fol- 
lows. 

The  nearer  civilization  is  approached,  the  more  trying  does 
the  ordeal  of  childbirth  become,  as  in  the  case  of  the  Umpquas 
just  cited.  I  am  told  that  among  the  women  of  the  Green 
Bay  Indian  Agency  many  deaths  take  place,  and  yet  a  physi- 
cian states  that  he  does  not  know  of  monstrosities  or  deformed 
pelves,  but  attributes  the  misfortune  to  malpositions ;  a  greater 
number  of  half-breeds  is  to  be  found  among  them,  and  the  re- 
sulting disparity  between  the  child  and  its  mother  may  be  a 
cause  of  the  trouble;  again  it  may  be  the  less  active  lives 
which  they  are  supposed  to  lead,  and  the  consequent  cross- 
births.  Dr.  Williams  has  observed  that  the  Pawnees  are  more 
exempt  from  accidents  than  the  Mnenionees,  and  inquires 
whether  it  is  on  account  of  the  squatting  posture  assumed  by 
the  Pawnee  women  in  labor ;  I  should  rather  aso-ibe  it  to  the 
more  active  life  led  by  the  Pawnees,  and  the  less  frequent 
intercourse  of  their  squaws  with  the  whites. 

We  see  then  certain  differences  and  an  increase  of  the 
difficulties  of  labor  as  civilization  is  neared.  How  different 
are  the  conditions  upon  which  I  have  laid  stress  as  existing 
among  savage  tribes,  from  those  which  we  find  in  our  centres 
of  luxury  !  People  intermarry  regardless  of  difference  in  race 
or  frame  of  body,  and  the  consequence  is  the  frequent  dispro- 
portion between  the  head  of  the  child  and  the  pelvis  of  the 


10  LABOR:    AN  ETHNOLOGICAL   STUDY. 

mother.  In  addition,  the  system  suffers  from  the  abuses  of 
civilization,  its  dissipations,  and  the  follies  of  fashion.  On 
account  of  the  idle  life  led,  and  the  relaxed  condition  of  the 
uterus  and  abdominal  walls,  there  is  a  greater  tendency  to 
malpositions ;  additional  difficulties  are  presented  by  the  weak- 
ened organization,  and  the  languid  neurasthenic  condition  of 
the  subjects  in  civilized  communities.  We  do,  however,  some- 
times find  in  our  cities,  more  frequently  in  our  rural  districts, 
strong  hardy  women,  who  lead  more  active  lives,  and  who  pass 
through  labor  with  an  ease  and  rapidity  much  more  like  that 
displayed  by  their  savage  sisters. 

I  can  hear  but  little  of  labor  troubles  from  physicians  who 
are  in  contact  with  our  Indians,  as  they  rarely  have  the  oppor- 
tunity of  witnessing  a  confinement ,  it  is  only  in  the  most 
desperate  cases,  and  hardly  then,  that  even  the  Agency  Phy- 
sician is  called  in,  and  Indians  are  extremely  reticent  upon 
such  topics ;  but  I  should  judge  from  the  robust  health  and 
hardiness  of  their  squaws  that  mishaps  are  few.  The  most 
serious  accident  which  occurs  is  the  shoulder  presentation,  and 
that  must  necessarily  prove  fatal.  This  rarity  of  accidents  is 
most  fortunate,  since  neither  our  own  Indians  nor  other  savage 
tribes  have  any  means  of  meeting  them,  save  incantations  or 
the  howling  of  the  medicine  men. 

The  Papagos  and  some  other  tribes  seem  to  have  a  philo- 
sophical way  of  regarding  accidents  in  labor  ;  they  think  that 
the  character  of  the  fetus  has  a  good  deal  to  do  in  causing  the 
obstruction,  and  the  more  severe  the  latter  the  worse  the 
former;  hence,  they  deem  it  better  for  mother,  child,  and 
tribe  that  the  mother  and  child  should  perish,  than  that  so 
villainous  an  offspring  should  be  born  and  grow  up  to  do  injury 
to  his  people. 

Rigidity  of  the  perineum  has  been  occasionally  mentioned, 
and  in  a  case  of  this  kind  among  the  Dakotas  the  attending 
squaw  relieved  her  patient  by  inserting  her  open  hands,  placed 
palm  to  palm,  within  the  vulva,  and  making  forcible  dilatation, 
an  assistance  which  few  other  uneducated  people  seem  to  have 
the  knowledge  of  rendering.  No  attention  being  paid  to  the 
perineum,  rupture  is  probably  frequent ;  I  know  this  to  be  a 
fact  only  of  the  negroes  of  Loango,  as  the  information  gathered 
by  travellers  does  not  usually  extend  to  these  subjects. 


PREGNANCY   PARTURITION,  AND   CHILDBED.  \\ 

The  prolapse  of  an  arm  is  managed,  among  the  Nez-Perces, 
and  undoubtedly  among  other  tribes  also,  just  as  it  is  by  some 
of  our  midwives,  by  pulling  upon  it,  as  they-do  upon  any  part 
which  chances  to  present. 

Prolapse  of  the  uterus  is  not  unusual  in  Mexico  and  quite 
frequent  in  the  interior  of  Russia.  The  Sclavonians,  for 
instance,  who  are  not  unlike  some  of  our  Indians,  endeavor  to 
shake  the  child  out  of  the  womb  in  cases  of  prolonged  labor; 
the  natural  consequence  is  that  both  the  child  and  placenta 
drop  out,  to  be  followed  not  unfrequently  either  by  prolapse 
or  inversion  of  the  uterus.  In  Russia,  these  accidents  are  so 
common  that  people  are  always  prepared  to  correct  them ;  the 
poor  sufferer  is  at  once  brought  into  the  bath-room  and 
stretched  upon  a  slanting  board,  the  feet  higher  than  the  head  ; 
then  the  board  with  the  patient  upon  it  is  successively  raised 
and  lowered  in  order  to  shake  the  uterus  back  into  the  pelvis, 
precisely  as  one  would  shake  a  pillow  into  its  cover. 

Hemorrhage,  of  which  I  do  not  often  hear,  is  treated  in 
some  instances  by  sousing  the  patient  into  the  nearest  stream, 
or  rather  more  tenderly  by  the  Santees,  where  the  attendant 
gives  the  patient  a  shower-bath  by  filling  the  mouth  with  water 
and  blowing  it  over  the  abdomen  with  as  much  force  as  possi- 
ble until  the  flow  of  blood  ceases. 

Whatever  may  be  their  social  condition,  primitive  people 
preserve  a  certain  superstition  as  regards  woman  and  the  func- 
tions peculiar  to  her  sex.  In  many  tribes  it  is  customary 
to  set  apart  a  hut  or  lodge  to  which  the  woman  is  banished 
during  the  period  of  the  menstrual  flow ;  so  also  the  child- 
bearing  woman,  as  a  rule,  seeks  a  quiet  nook  away  from  the 
camp,  or  if  the  habits  of  the  people  are  more  sedentary,  she  is 
confined  in  a  separate  lodge  a  short  distance  from  the  one  oc- 
cupied by  the  family.  Sometimes  a  house  is  erected  for  this 
special  purpose,  common  to  the  entire  village.  Again,  if  better 
situated,  she  may  have  a  separate  room  in  her  own  house,  sa- 
cred for  these  occasions. 

On  the  Sandwich  Islands,  on  the  contrary,  the  confinement 
is  more  public  and  the  performance  is  witnessed  by  all  who 
happen  to  be  about.  The  same  lack  of  privacy  prevails  among 
the  Mohammedans  of  India,  who  are  as  careless  of  the 
privacy  of  their  confinements  as  they  are  of  their  copulations. 


1^  LABOR:    AN  ETHNOLOGICAL   STUDY. 

The  wilder  tribes  of  Southern  India  allow  female  relatives 
and  friends  to  crowd  around  the  woman,  as  do  the  Aborigines 
of  the  Andaman  Islands.  The  Pahutes,  the  Brule-Sioux,  and 
the  Umpquas  conduct  the  abor  m  the  family  lodge,  and  the 
sympathizing  as  well  as  tlie  curious  crowd  around  at  will.  A 
very  good  idea  of  such  a  scene  is  given  me  by  Dr.  Ed.  V. 
Yollum,  Surgeon  U.  S.  A.,  who  attended  the  wife  of  an  Ump- 
qua  chief.  He  states  that  he  found  the  patient  lying  in  a  lodge, 
rudely  constructed  of  lumber  and  driftwood;  the  place  was 
packed  to  suffocation  with  women  and  men ;  the  stifling  odors 
that  arose  from  their  sweating  bodies,  combined  v/ith  the  smoke, 
made  it  impossible  for  him  to  remain  in  the  apartment  longer 
than  a  few  moments  at  a  time.  The  assembly  was  shouting 
and  crying  in  the  wildest  manner,  and  cj.*owding  about  the  un- 
fortunate sufferer,  whose  misery  was  greatly  augmented  by  the 
apparent  kindness  of  her  friends.  Not  much  better  were  the 
half -civilized  Mexican  inhabitants  of  Monte  Rey  in  early  days  : 
but  even  in  these  cases  where  such  publicity  is  permitted,  men 
are,  as  a  rule,  excluded. 

Commonly  labor  is  conducted  most  privately  and  quietly  ; 
the  Indian  squaw  is  wont  to  steal  off  into  the  woods  for  her 
confinement.  Alone  or  accompanied  by  a  female  relative  or 
friend  she  leaves  the  village,  as  she  feels  the  approach  of  labor, 
to  seek  some  retired  spot ;  upon  the  banks  of  a  stream  is  the 
favorite  place  the  world  over,  the  vicinity  of  water,  moving 
water,  if  possible,  is  sought,  so  that  the  young  mother  can 
bathe  herself  and  her  child  and  return  to  the  village  cleansed 
and  purified  when  all  is  over.  This  is  true  of  the  Sioux,  the 
Comanches,  the  Tonkawas,  the  Nez-Perces,  the  Apaches,  the 
Cheyennes,  and  other  of  our  Indian  tribes. 

In  winter,  a  temporary  shelter  is  erected  in  the  vicinity  of 
the  family  lodge  by  those  who  make  the  solitude  of  the  forest 
their  lying-in  chamber  in  milder  weather. 

The  Chippewas,  as  well  as  the  "Winnebagos,  also  follow  this 
custom.  The  natives  of  the  Caucasus,  the  Dombars  and  other 
tribes  of  Southern  India,  those  of  Ceram,  the  inhabitants  of 
Loango,  of  Old  Calabar,  and  many  of  tlie  African  races,  are 
delivered  in  this  quiet  way,  and  the  women  are  not  only  kept 
apart  from  their  husbands  and  the  villagers  during  their  con- 
finement, but  for  weeks  afterwards.     The  reason  why  we  know 


PREG NANCY,  PARTURITION,  AND   CHILDBED. 


13 


60  little  of  Indian  labor  is  the  great  secrecy  which  they  observe 
regarding  such  matters,  and  their  extreme  reluctance  to  speak 
to  inquisitive  whites  of  these  subjects  which  are  to  them  en- 
shrouded in  a  veil  of  superstition  and  mystery. 

Some  of  the  Sioux  tribes,  tlie  Blackfeet  and  the  Uncapapas, 
are  in  the  habit  of  arranging  a  separate  lodge,  generally  a 
temporary  one,  for  the  occasion,  as  also  do  the  Klamaths,  the 
Utes,  and  others.  The  Comanches  construct  a  shelter  for 
parturient  women  a  short  distance  outside  of  the  camp  and 
in  the  rear  of  the  patient's  family  lodge.  This  is  made  of 
brush  or  bushes,  six  or  seven  feet  high,  stuck  into  the  hard 
ground,  the  branches  intertwining  so  as  to  form  a  circular  shel- 
ter about  eight  feet  in  diameter,  an  entrance  is  provided  by 
breaking  the  circle  and  overlapping  the  two  unjoined  ends.    In 


Fig.   2.— Temporary  shelter  for  the  lying-in  woman,  Comanches. 

a  line  outside  the  entrance  are  placed  three  stakes  made  from 
the  stems  of  small  saplings  with  the  bark  ^ eft  on;  these  ai'e 
set  ten  paces  apart  and  are  four  feet  high.  Inside  the  shel- 
ter are  made  two  rectangular  excavations  in  the  soil,  ten  to 
eighteen  inches  in  width,  with  a  stake  at  the  end  of  each.  In 
one  hole  is  placed  a  hot  stone,  in  the  other  a  little  loose  earth 
to  receive  any  discharges  from  the  bowels  or  the  bladder. 
The  ground  is  strewn  with  herbs.  This  is  their  usual  mode  of 
constructing  a  shelter  when  in  camp,  and  at  other  seasons, 
when  boughs  fail  them,  pieces  of  cloth  are  used  to  cover  up 
the  gaps,  or  else  the  leafless  brush  is  covered  with  skins  ;  but 
on  the  march  some  natural  protection  is  usually  sought,  or  one 
is  hastily  extemporized  out  of  robes  with,  perhaps,  a  lariat 


14  LABOR:    AN  ETHNOLOGICAL    STUDY. 

attached  to  the  nearest  tree  for  the  woman  to  seize  during  the 
pains. 

The  Indians  of  the  Uinta  Yalley  Agency  observe  a  similar 
custom.  At  the  first  indication  of  labor-pains,  the  parturient 
leaves  the  lodge  occupied  by  her  family,  and  a  short  distance 
from  it  erects  for  herself  a  small  "  wick-e-xijp^''  in  which  to 
remain  during  her  confinement,  first  clearing  the  ground  and 
making  a  slight  excavation  in  which  a  fire  is  kindled ;  rocks 
are  placed  around  the  fire  and  heated,  and  a  kettle  of  water  is 
kept  hot,  from  which  copious  draughts  are  frequently  taken. 
The  ^^wick-e-ujp^^  is  made  as  close  as  possible,  to  prevent  ex- 
posure to  changes  of  temperature,  and  to  promote  free  perspi- 
ration. Assistance  is  given  by  squaws  living  in  the  neighbor- 
hood, but  no  particular  one  is  chosen,  nor  is  any  medicine-man 
called  in  to  render  aid.  In  Ceram,  a  temporary  hut  is  hastily 
built  in  the  woods,  and  in  some  parts  of  the  interior  of  Russia 
a  separate  house  is  provided,  as  among  our  own  Indians; 
such  is  also  the  custam  of  the  Samojedn.  The  Gurians  make 
use  of  a  special  room  in  the  house ;  the  apartment  set  aside 
for  this  purpose  has  no  fiooring,  but  the  ground  is  plentifully 
strewn  with  hay,  upon  which  tlie  bed  is  made ;  above  this 
a  rope  is  fastened  to  the  ceiling  for  the  woman  to  grasp  when 
in  pain.  The  usual  and  favorite  place  of  confinement  for  the 
Laps  and  other  polar  tribes  is  the  bath-room. 

As  the  place  of  confinement  varies,  so  does  the  couch  upon 
which  the  labor  occurs.  Some  care  is  devoted  to  its  prepara-  | 
tion  by  all  people,  even  the  Susruta,  that  ancient  system  of 
midwifery,  tells  us  that  "  the  parturient  should  lie  on  her  back 
upon  a  carefully  spread  couch,  that  a  pillow  should  be  given 
her,  the  thighs  should  be  flexed,  and  that  she  should  be  deliv- 
ered by  four  aged  and  knowing  midwives,  whose  nails  were 
well  trimmed." 

The  women  of  ancient  Greece  were  delivered  upon  stools  ; 
the  large  arm-chair  is  still  at  home  in  the  East,  while  in  Syria 
a  rocking  obstetrical  chair  is  used.  The  Kootenais  employ  a 
box  covered  with  buffalo  robes;  the  Sandwich  Islanders,  a 
stone ;  and  certain  of  the  tribes  of  Finns  and  Mongols,  as  well 
as  many  of  our  Caucasian  race,  look  upon  the  lap  of  the  hus- 
band as  the  best  obstetrical  couch.  Many  of  our  Indians  use 
nothing  but  the  bare  ground,  others  a  buffalo  robe  or  old 


PREGNANCY,  PARTURITION,  AND    CHILDBED. 


15 


blanket  spread  upon  the  floor  of  the  tejpee,  or  else  some  dried 
grass  and  weeds ;  in  one  way  or  other,  liowever,  they  make  a 
soft  and  comfortable  couch  upon  the  ground.  A  common 
method  is  to  place  a  layer  of  earth  beneatli  the  bnfialo  robe 
upon  which  they  are  confined.  Thus  F.  F.  Gerard  tells  me 
that  the  Rees,  the  Gros- Ventres,  and  the  Mandans,  lay  a  large 
piece  of  skin  on  the  ground,  over  which  is  strewn  a  layer  of 
earth  three  to  four  inches  deep,  and  upon  this  is  spread  the 
blanket  or  skin  on  which  the  parturient  kneels. 

The  Japanese  make  their  preparations  for  the  coming  event 
in  the  seventh  month,  so  as  to  be  sure  of  being  in  time.  The 
bed  which  they  then  provide  consists  of  a  mat  of  straw  about 
three  feet  square,  on  which  is  spread  a  layer  of  cotton  or  cloth. 
This  simple  arrangement  upon  which  the  patient  is  to  be  de- 
livered is  then  set  aside  to  be  available  at  any  emergency. 


Fig.   3. — Japanese  lying-iu  couch  and  supports  used  in  childbed. 


The  above  figure  represents  this  mat,  together  with  the  mat- 
tress upon  which  it  is  laid,  and  the  cushions  used  to  support 
the  back  during  the  puerperal  state.  I  need  enter  no  further 
into  this  subject,  as  I  have  frequently  referred  to  it,  and  have 
treated  of  it  fully  in  my  paper  on  Posture. 

With  regard  to  the  assistants  who  aid  the  parturient  woman, 
there  is  some  difference  in  the  customs  of  the  various  races. 
In  many  cases  she  has  no  help  of  any  kind.  As  a  rule,  the 
assistants,  if  any,  are  females,  relatives,  or  neighbors,  and  the 


16  LABOR:    AN  ETHNOLOGICAL    STUDY. 

aid  they  give  the  sufferer  is  about  the  same  as  that  which  is 
too  commonly  obtained  by  her  more  civilized  sisters,  the  world 
over,  often  worse  than  none  at  all.  Occasionally  they  have 
professional  midwives,  whose  qualifications  depend  chiefly 
upon  their  age  or  the  number  of  children  they  have  borne. 
In  case  that  the  patient  is  a  lady  of  quality,  the  wife  perhaps 
of  a  chief,  or  if  the  labor  prove  a  very  difiicult  one,  the  pro- 
phet or  medicine  man  is  summoned.  The  physician  is  mis- 
trusted and  is  only  consulted  in  the  most  desperate  cases  ;  the 
medicine  man  is  aware  that  the  forceps  of  his  white  brother 
are  more  efficacious  than  the  rattling  of  the  tum-tum,  and, 
actuated  by  that  same  professional  jealousy  which  is  occasion- 
ally observed  in  more  civilized  communities,  he  uses  his  influ- 
ence to  malign  the  stranger,  and  glorify  himself.- 

In  Siam  and  in  Ceram,  in  parts  of  Africa  and  South  Amer- 
ica, among  the  Indians  of  Canada  and  some  of  our  own — the 
Tonkawas,  the  Oheyennes  and  allied  tribes,  the  Arrapahoes, 
and  the  Cattaraugus,  there  is  no  class  corresponding  to  our  mid"- 
wives,  and  the  patient  has  no  help  whatsoever ;  but  usually 
relatives  and  friends  aid  each  other,  or  there  is  some  assistance 
rendered  by  the  habitual  old  woman.  This  is  true  of  the  sav- 
age tribes  of  the  vast  Russian  empire  ;  each  village  or  settle- 
ment has  an  old  crone  who  possesses  the  power  of  second  sight, 
and  by  this  gift  and  other  similar  means  drives  away  disease ; 
but  above  all  haunts  the  lying-in  room,  where  she  causes  much, 
harm  to  both  mother  and  child  by  her  rude  and  ill-timed  man- 
ipulations. Other  tribes  have  their  particular  old  women, 
who,  for  various  reasons,  are  supposed  to  be  specially  skilled. 
Thus  the  Navajos  and  the  Nez-Perces  have  their  sages  femmeSy 
and  in  Mexico  there  are  midwives  who  are  acquainted  with 
medicinal  herbs  and  their  properties.  The  Indians  of  the 
Quapaw  Agency,  those  in  some  parts  of  Mexico,  and  many  of 
the  Pueblos  have  women  who  make  this  a  specialty.  So  also 
the  Klatsops,  the  Klamath,  the  Rees,  the  Gros- Ventres,  and  the 
Mandans. 

Whenever  a  midwife  or  some  other  old  woman  assists  the 
progress  of  labor,  one  or  more  younger  women  are  always  on 
hand  to  perform  the  actual  work,  whilst  the  midwife  sits  in 
front  of  her  charge  to  receive  the  child.  In  Syria,  the  assist- 
ant is  an  old  woman  who  learned  her  trade  by  practising  with 


PREGNANCY,  PARTURITION,  AND    CHILDBED.  17 

her  mother  who  was  a  midwife  before  her  ;  it  is  necessary  for 
a  woman  thereto  practise  for  a  long  time  before  she  thoroughly 
gains  the  confidence  of  the  people.  We  find  midwives  also  in 
Japan,  in  parts  of  India,  where  in  ancient  times  only  women 
assisted  the  parturient,  whilst  in  ancient  Egypt  difficult  cases 
were  attended  by  surgeons  specially  skilled  in  midwifery,  as  it 
will  be  remembered  that  they  had  their  specialists  as  well  as 
we  of  the  present  day.  Susruta  speaks  of  'midwives  attending 
his  patient,  and  the  mention  of  midwives  in  Exodus  i.  19  im- 
plies that  these  good  women  were  as  unskilful  thirty-five  cen- 
turies ago  as  they  can  still  be  found  at  the  present  day.  From 
all  that  we  have  seen  it  appears  that  the  Yi  of  India,  the  Dye 
of  Syria,  the  herb-knowing  hag  of  Mexico,  and  the  midwife  of 
the  Bible  are  very  much  the  same  in  their  habits,  their  quali- 
fications, and  their  knowledge.  It  is  the  same  habitual  old 
woman  who  figures  in  all  countries  and  at  all  times,  and  with 
whose  peculiar  qualifications  we  are  quite  familiar.  In  cases 
where  the  midwife  is  at  a  loss,  the  aid  of  the  medicine  man  is 
sought.  The  Baschkirs  rely  upon  their  "  devil-seer  "  who  dis- 
covers the  presence  of  the  evil  spirit  and  drives  him  away  if 
rewarded  by  the  present  of  a  sum  of  money  or  a  fat  sheep. 
Among  others  a  priest  is  called  who  hastily  mumbles  a  few 
verses  of  the  Koran,  spits  into  the  patient's  face,  and  leaves 
the  rest  to  nature. 

The  assistance  which  is  rendered  to  the  parturient  woman  is 
very  simple  and  consists  entirely  of  external  manipulations, 
support  of  the  patient  in  whatever  position  she  may  be  con- 
fined, together  with  compression  of  the  abdomen  for  the  pur- 
pose of  expressing  the  child :  in  addition  to  this,  the  incanta- 
tions of  the  medicine  men  as  well  as  other  means,  by  which 
they  endeavor  to  act  upon  the  imagination  of  the  patient,  must 
not  be  forgotten.  How  littfe  actual  help  the  lying-in  woman 
receives,  and  how  limited  is  their  knowledge  of  correcting  mal- 
position or  other  of  the  accidents  of  labor,  will  be  readily  per- 
ceived if  we  state  that  but  few  of  those  primitive  people,  whose 
habits  we  have  so  far  considered,  ever  manipulate  within  the 
vagina.  I  have  positive  statements  to  this  effect  from  the  In- 
dians of  the  Pacific  coast,  the  Umpquas,  the  Pueblos,  as  well 
as  the  natives  of  Mexico.  The  introduction  of  the  hand  into 
the  vagina  or  into  the  uterus  for  any  definite  purpose  is  a  mani- 


18  LABOR:    AN  ETHNOLOGICAL    STUDY. 

pulation  unknown  to  the  natives  of  other  countries  as  well.  At 
least  I  never  see  it  referred  to  unless  it  be  in  a  few  instances 
for  the  purpose  of  distending  the  perineum  or  of  removing  the 
placenta  from  the  vagina,  which  must  remain  if  retained  in 
utero.  The  midwife  or  older  woman  in  attendance,  as  we 
have  seen,  usually  receives  the  child,  whilst  the  younger 
women  support  the  patient,  steadying  the  pelvis,  resting  her 
head  and  shoulders,  and  holding  her  arms  and  legs  according 
to  the  position  which  she  assumes.  The  younger  women  also 
compress  the  abdomen  and  rub  the  body  wherever  directed. 
The  most  reasonable  of  all  their  means  of  assisting  the  patient 
in  her  labor  is  the  steady  compression  of  the  abdomen  and  the 
following  down  of  the  child  in  its  descent.  This  is  a  feature 
common  to  the  red,  yellow,  and  black  races,  be  it  by  compres- 
sion of  the  fundus,  by  the  encircling  arms  of  the  husband  upon 
whose  lap  the  patient  rests ;  be  it  by  the  hands  of  one  of  the 
female  assistants  sometimes  from  behind,  sometimes  from  the 
front ;  or  by  a  broad  cloth  or  binder  (California  Indians  and 
the  natives  of  Southern  India)  which  an  assistant  tightens 
during  each  pain — a  treatment  which  has  not  yet  lost  the  favor 
of  obstetricians  and  was  once  quite  popular.  There  ai*e  some 
who  still  place  a  towel  about  the  abdomen  of  their  patients, 
thinking  to  assist  the  descent  of  the  child  by  the  pressure  exer- 
cised; it  serves  both  to  correct  the  direction  of  the  child's 
descent  and  to  hasten  its  passage.  In  its  extreme  and  worst 
feature  we  see  this  method  of  treatment  exemplified  by  the 
Siamese  who  seek  to  force  the  expulsion  of  the  fetus  in  diffi- 
cult cases  by  permitting  the  attendant  to  trample  upon  the  ab- 
domen of  the  patient  who  is  lying  prone  upon  her  back. 

All  primitive  people  resort  to  expression  in  one  way  or 
another.  The  Finns,  in  tedious  cases,  compress  the  abdomen 
by  a  belt  or  binder  of  some  kind  or  by  holding  the  patient 
up,  suspended,  and  shaking  her  as  they  would  a  pillow  out  of 
its  case — a  proceeding  which  is  more  efficient  than  mild,  and 
serves  as  a  last  resort  to  the  natives  of  Mexico  as  well  as 
other  far  distant  people.  In  Syria,  some  effort  is  made  to  sup- 
port the  perineum  in  the  same  manner  as  is  usual  with  us.  In 
Mexico,  as  I  have  already  said,  they  seek  to  overcome  the  ten- 
sion by  the  introduction  of  the  hands,  and  in  India  the  parts 
are  carefully  anointed,  as  it  is  done  by  some  of  our  Western 


PREGNANCY,  PARTURITION,  AND  CHILDBED.  19 

tribes.  The  description  of  an  Indian  labor,  as  given  me  by 
Dr.  McCoy  from  his  experience  at  the  Nisqually  agency,  will 
srive  an  excellent  idea  of  the  assistance  which  is  tendered  the 
Indian  woman  in  her  confinement.  "  The  midwives,  of  whom 
there  are  two  in  attendance,  call  upon  the  Great  Spirit  for 
help  in  a  muttering  tone,  and  in  the  same  tones  name  over  the 
parts  immediately  connected  with  the  parturient  effort,  and 
often  all  the  joints  and  limbs  of  the  body.  By  applying  their 
hands  to  the  abdominal  walls  they  try  to  ascertain  the  position 
of  the  fetus  in  utero  and  usually  to  correct  malpresentation. 
They  use  oil  to  anoint  the  parts,  and  just  before  the  expul- 
sion of  the  child  give  medicines  to  increase  the  pains." 

Somewhat  similar  was  the  experience  of  Dr.  Shortt  among 
the  natives  of  Southern  India,  He  says:  "  When  the  woman 
is  taken  with  labor  pains,  her  relatives  and  family  friends 
come  in  and  crowd  around  the  sufferer,  who  is  directed  to  walk 
about.  The  midwife,  an  old  woman  of  experience,  rubs  her 
with  oil  and  bathes  her  back,  loins,  and  lower  extremities  in 
warm  water ;  if  the  pains  are  false,  the  woman  may  partake 
of  food,  but  after  the  commencement  of  labor  nothing  is  given. 
She  is  made  to  sit  with  her  legs  extended,  one  assistant  sup- 
porting her  back,  whilst  the  nurse  shampoos  back  and  loins, 
and  her  friends  keep  up  a  constant  noise  by  talking.  Prior 
to  the  rupture  of  the  membranes,  the  nurse  places  a  bag  tilled 
with  ashes  under  the  perineum  as  a  support  and  to  prevent  the 
clothes  being  stained.  The  pelvis  and  abdomen  are  rubbed 
with  a  limpid  oil  and  shaken  several  times  to  promote  delivery. 
The  membranes  are  not  ruptured  ;  this  is  left  to  nature ;  when 
the  head  protrudes  the  nurse  supports  it  with  her  hands  and 
directs  the  woman  to  lie  on  her  back." 

Little  is  known  to  these  people  of  the  assistance  given 
by  the  abdominal  muscles,  a  help  which  has  been  recognized 
even  in  ancient  times  and  so  judiciously  advocated  by  Sus- 
ruta,  who  limits  the  efforts  of  the  patient  to  the  expul- 
sive pains  and  advises  more  or  less  use  of  the  abdominal 
muscles  according  to  the  progress  made  by  the  head  of 
the  child.  The  influence  of  the  emotions  is,  however,  thor- 
oughly recognized,  as  is  evident  by  the  incantations  to  which 
the  prophets  of  the  tribe  resort.  In  Russia,  in  India,  and 
America,  a  sudden  shock  is  often  made  use  of  and  proves  a 


20  LABOR:    AN  ETHNOLOGICAL    STUDY. 

wonderful  help  in  hastening  the  expulsion  of  the  child ;  it  is 
appreciated  as  such  by  the  Kalmucks  who  always  have  a  num- 
ber of  men,  with  their  guns  in  readiness,  waiting  near  the  bed 
of  the  patient ;  as  soon  as  the  midwife  perceives  the  head  dis- 
tending the  perineum  she  signals  the  men  who  fire  simulta- 
neously, thinking  to  assist  nature  by  the  sudden  fright  which 
the  noise  must  cause.  A  similar  practice  is  occasionally  re- 
sorted to  among  the  Comanches,  and  Dr.  Forwood,  who  at- 
tended a  Comanche  squaw  in  a  diflicult  labor,  told  me  that  at 
a  former  confinement  of  the  same  patient,  a  practical  applica- 
tion had  been  made  of  the  effect  of  fright.  Slie  was  brought 
out  on  the  plain  and  Eissehahy,  a  noted  warrior,  mounted  on 
his  fleetest  steed,  with  all  his  war  paint  and  equipments  on, 
charged  down  upon  her  at  full  speed,  turning  aside  only  at  the 
last  moment  when  she  expected  to  be  pierced  through  the  body 
and  trampled  under  foot.  This  terrible  ordeal  is  said  to  have 
been  followed  by  the  immediate  expulsion  of  the  child. 

Besides  the  incantations  which  are  customary  as  a  last  resort 
in  diflicult  cases,  there  are  a  great  many  ridiculous  superstitions 
in  regard  to  labor,  and  much  nonsense  is  practised  with  the 
view  of  making  labor  easy.  Thus  in  the  middle  ages  the  stars 
were  consulted.  Some  of  the  most  northern  of  the  Russian 
tribes  think  to  make  labor  easy  by  obliging  the  parturient  to 
give  the  names  of  such  men,  besides  her  husband,  with  whom 
she  has  cohabited,  and  he,  by  a  messenger,  informs  the  midwife 
of  his  own  misdeeds  in  that  direction.  Should  the  labor  prove 
a  difficult  one,  notwithstanding  this  important  proceeding,  it  is 
ascribed  to  a  false  statement  on  the  part  of  husband  or  wife. 
Tlie  Finns  kill  a  chicken  and  hold  the  animal  struggling  in  the 
agony  of  death  before  the  pudenda  of  the  mother.  Another 
custom  of  theirs  is  to  ply  the  husband  with  beer,  mixed  with 
LeduTYi palustre,  upon  the  eve  of  his  wedding  day,  in  order  to 
produce  deep  sleep,  during  which  the  wife  crawls  through  be- 
tween the  husband's  legs  without  his  noticing  it.  But  no  more 
of  this.  All  of  these  various  superstitions  are  equally  as 
efficacious  as  the  incantations  of  the  Klamath  squaw  who  tells 
the  child,  as  slie  anxiously  watches  the  progress  of  the  labor, 
that  a  rattlesnake  was  coming  to  bite  it,  if  it  does  not  hurry 
into  the  world  and  leave  its  present  abode. 

Although  most  savage  tribes  have  roots  and  herbs  to  which 


PREGNANCY,  PARTURITION,  AND  CHILDBED.  21 

they  resort  in  various  diseases,  they  rarely  seem  to  make  Tise  of 
them  during  hibor.  We  have  just  seen  that  the  Indians  of 
"Washington  Territory  give  some  medicine  just  before  the  ex- 
pulsion of  the  child,  and  that  TJva  ursi  is  used  by  others.  The 
tribes  of  Russia  use  a  decoction  of  Artemesia  vulgaris  to  in- 
crease the  pain  ;  in  the  same  way  Achillea  inillefolium  is  used, 
and  this  latter  is  universally  resorted  to  in  all  uterine  troubles. 
In  the  government  Riasan,  Comaruin  jpalustre  is  used.  The 
Esthonians  give  the  patient  a  decoction  of  valerian  with  beer. 
Those  who  have  no  medicines,  or  cannot  afford  them,  in  the 
interior  of  Russia,  let  the  patient  blow  with  all  her  force  into 
an  empty  bottle,  or  place  a  vessel  or  pot,  like  a  surgical  cup, 
upon  the  abdomen,  or  they  make  the  poor  woman  swallow 
some  ashes  or  a  few  lice  in  place  of  other  medicine. 

We  have  seen  that  the  Indians  of  the  Uinta  Valley  Agency 
drink  a  good  deal  of  hot  water  during  labor.  The  Crow  In- 
dians of  Montana  drink  tea  made  of  various  roots  and  leaves, 
the  kind  preferred  being  made  from  the  root  of  a  plant  called 
E-say^  said  to  resemble  the  tobacco  plant,  with  a  root  about 
as  large  as  a  turnip.  Small  quantities  of  whiskey  are  also  fre- 
quently given  during  labor,  and  so  much  importance  is  at- 
tached to  this  that  any  price  will  be  paid  for  a  pint  or  two 
which  is  frequently  carried  about  for  months  before  it  is  to  be 
used.  The  Winnebagos  and  Chippewas  give  the  patient,  just 
before  the  delivery  of  the  child,  a  drink  from  a  root  steeped  in 
hot  water  which  is  supposed  to  relax  the  system  and  make 
delivery  quick  and  easy.  The  Indians  of  the  Skokoraish 
agency  use  a  tea  made  from  the  leaves  of  TJva  ursi  which  they 
believe  from  their  own  experience  to  possess  oxytocic  proper- 
ties. In  India,  it  is  considered  very  dangerous  for  the  patient 
to  drink  water  during  labor.  In  ancient  Mexico,  a  decoction 
of  the  root  of  a  plant  called  civapacthi^  which  possessed  some 
oxytocic  properties,  was  given,  but  if  the  pains  were  too  severe, 
a  small  piece  of  the  tail  of  an  opossum,  carefully  rubbed  down 
in  water,  had  to  be  taken.  However  ridiculous  this  may  seem, 
it  is  not  more  so  than  a  prescription  given  by  the  court  physi- 
cion  in  Siam  to  a  lady  of  high  rank  at  the  time  of  her  confine- 
ment :  "  Rub  together  shavings  of  sapan  wood,  rhinoceros 
blood,  tiger's  milk  (a  fresh  deposit  found  on  certain  leaves  in 
the  forest),  and  cast-off  skins  of  spiders."     The  Sandwich  Isl- 


i 


22  LABOR:    AN  ETHNOLOGICAL   STUDY. 

anders  drink  freely,  before  confinement,  from  a  mucilage  pre- 
pared from  the  inner  bark  of  the  halo  or  hibiscus  tree.  Sus- 
ruta  advises  the  parturient  to  drink  quantities  of  sour  rice 
gruel.  In  southern  India,  it  is  still  customary  to  take  some 
food  in  the  early  stages  of  labor,  but  as  soon  as  the  pains  dis- 
tinctly set  in,  no  more  is  permitted.  Where  labor  is  so  short, 
^there  is  little  opportunity  to  take  food,  hence  little  can  be  said 
of  the  customs  of  primitive  people  during  labor  in  this  respect. 
Whatever  villanous  decoctions  the  lying-in  woman  may  be 
obliged  to  take,  her  labor,  as  we  have  seen,  is,  as  a  rule,  an  easy 
one,  and  if  we  consider  in  connection  with  this  the  stoic  char- 
acter of  the  Indian,  we  will  not  be  astonished  that  during  the 
throes  of  labor  the  mother  is  usually  dumb  and  patient,  and 
willing  that  the  child  should  inflict  any  pain  to  accomplish  the 
delivery.  Although  comparatively  quiet,  at  the  recurrence  of 
each  pain  the  parturient  woman  will  frequently  utter  a  plain- 
tive cry,  and  in  this  she  differs  somewhat  from  her  white  sister ; 
the  latter  will  most  frequently  announce  the  occurrence  of 
pain  by  a  sound  which  by  the  old  women  has  been  determined 
"  grunt,"  the  former  gives  vent  to  a  low  plaintive  cry,  best 
expressed  perhaps,  by  the  words  "  wail ''  or  "  whine."  But 
sometimes  the  Indian  squaw  gets  noisy  and  restless  in  her  suf- 
fering, and  a  description  which  is  given  of  a  laboring  woman 
in  the  days  of  the  ancient  Hebrews,  some  thirty-five  centuries 
ago,  appears  much  more  natural  to  us  and  is  much  more  in 
accord  with  the  sufferings  which  we  suppose  a  woman  to  un- 
dergo. It  is  said  of  the  parturient  that  "  she  trembles  and 
writhes  in  her  pain"  (1  Sam.  iv.  19).  Her  face  is  all  aglow, 
she  sees  and  hears  nothing  in  her  anxiety,  especially  the 
primipara  cries  out  aloud  and  says,  with  extended  hands,  "  Woe 
unto  me,  for  my  soul  succumbs  to  the  murderers"  (Gen.  iii, 
16).  And  for  men  there  seems  to  be  no  greater  threat  than 
"  the  heroes  of  Moab  will  upon  that  day  show  a  bravery  equal 
to  that  of  a  woman  in  labor  pains  "  '  (Jer.  xlviii.  41 ;  xlix.  22). 

CHILDBED. 

As  I  have  treated  fully  of  the  third  stage  of  labor  in  my 
last  paper,  I  shall  in  no  way  here  refer  to  it,  but  will  at  once 
pass  to   the  consideration  of  the  puerperal  stage,  and  as  so 

'  Kotelman :  Die  Geburtshiilfe  bei  den  alten  Hebraern. 


PREGNANCY,  PARTURITION,  AND    CHILDBED.  23 

little  attention  is  paid  to  the  treatment  of  the  patient  during 
that  period,  I  shall  conline  myself  to  the  treatinent  immedi- 
ately after  delivery,  as  she  is  then  for  a  few  moments  still 
under  the  control  of  the  midwife  or  attendant,  and  something 
is  always  done  before  she  is  permitted  to  go  to  her  home  or  her 
place  of  retirement  through  the  period  of  uncleanliness  that 
follows. 

Among  the  Apaches,  it  is  deemed  very  essential  that,  as  soon 
as  the  placenta  is  expelled,  the  woman  should  be  kept  on  her 
feet,  walking  about  for  half  an  hour  or  more,  so  as  to  favor  a 
free  discharge  of  all  retained  blood  and  prevent  its  coagulation 
in  the  womb.  The  same  custom  is  observed  among  the  Da- 
kotas,  among  the  Flat-Heads,  Pend-d'oreilles,  Kootenais,  and 
among  other  of  the  Indians  of  the  Pacific  coast,  and  wherever 
it  is  not  especially  mentioned  I  should  suppose  that  the  custom 
was  at  least  unconsciously  observed,  because  it  is  rarely  the 
case  that  the  Indian  squaw  remains  abed  after  her  confinement ; 
she  certainly  moves  about  sufiiciently  to  accomplish  the  end 
desired,  even  if  it  is  not  done  with  the  purpose  definitely  in 
view.  It  will  be  remembered  that  upon  the  banks  of  a  stream 
was  the  place  usually  sought  by  the  laboring  woman  among 
primitive  people  the  world  over  for  her  solitary  confinement ; 
delivered  of  her  child  she  bathes  in  the  cleansing  waters — this 
is  done  by  most  of  our  Indians,  by  some  of  the  natives  of 
Africa,  the  inhabitants  of  Ceram,  the  still  savage  tribe  of  the 
Yurakere,  by  the  natives  of  Bolivia,  the  Sandwich  Islands,  the 
Antilles,  and  of  India.  It  is  everywhere  the  same ;  the  mother, 
usually  with  her  babe  in  her  arms,  plunges  into  the  stream  to 
cleanse  herself;  or,  if  the  labor  is  conducted  by  a  midwife,  she 
leads  the  patient  to  the  water  where  she  is  a\  ashed  secundem 
artem,  redressed,  and  then  allowed  to  return  to  her  place  of  se- 
clusion or  to  her  home,  and  very  frequently  to  work,  according 
to  the  varying  customs  among  diflferent  tribes. 

Among  many  of  the  tribes  of  the  Sclavonians,  several 
buckets  of  warm  water  are  pom-ed  over  the  patient's  ab- 
domen; the  Klamaths  steam  themselves — a  custom  which 
they  continue  for  several  days  after  delivery.  The  Pa- 
hutes  also  continue  their  ablutions  frequently  for  days 
after  confinement,  mother  and  father  both  indulging  in 
frequent  washings  in  imitation  of  some  original  first  parents, 


24  LABOR:    AN  ETHNOLOGICAL   STUDY. 

whom  tradition  informs  them  were  very  cleanly.  The  Siamese 
cleanse  themselves  vritli  still  greater  thoroughness,  but  with 
fire  instead  of  water ;  "  with  the  expulsion  of  the  child  begins 
a  month  of  penance  for  the  mother — exposure  to  true  purga- 
torial fires.  It  is  ingrown  into  the  native  female  mind  in  Siam 
that  the  most  direful  consequences  to  both  mother  and  child 
will  ensue,  unless  for  thirty  days  after  the  birth  of  her  first 
child — a  period  diminished  five  days  at  each  subsequent  birth 
— she  exposes  her  naked  abdomen  and  back  to  the  heat  of  a 
blazing  fire,  not  two  feet  distant  from  her,  kept  up  incessantly 
day  and  night.  They  think  the  due  quantity,  quality,  and 
duration  of  the  lochial  discharge  depends  on  their  exposure  to 
the  fire.  And  this  is  done  in  the  following  way:.  A  fireplace 
is  brought  in  or  extemporized  on  the  floor  of  the  lying-in 
chamber,  by  having  a  flat  box  or  a  simple  rectangular  frame- 
work of  planks  or  trunks  of  banana  trees,  some  three  feet  by 
four,  filled  in  with  earth  to  the  depth  of  six  inches.  On  this 
the  fire  is  built  with  sticks  of  wood  nearly  or  quite  as  large  as 
one's  wrists.  By  the  side  of  this  oblong  frame,  and  in  contact 
with  it,  raised  to  a  level  with  the  fire,  a  piece  of  board  six  or 
seven  feet  in  length  is  placed,  and  on  this  a  coarse  mat  spread ; 
upon  this,  or  on  the  bare  plank  itself  the  unfortunate  woman 
lies  quite  nude,  save  with  a  narrow  strip  of  cloth  about  her 
hips ;  with  nothing  else  to  secure  her  from  a  fire  hot  enough 
to  roast  a  duck.  Then,  acting  as  her  own  turnspit,  she  exposes 
front  and  back  to  this  excessive  heat — an  experience  not  to  be 
coveted  in  any  land,  but  in  that  bm*ning  clime  of  perpetual 
summer  a  fiery  trial  indeed.  The  husband  or  nurse  is  ever 
hard  by,  like  her  evil  genius,  to  stir  up  and  replenish  the  fire 
by  night  and  by  day.  True,  if  it  blazes  up  too  fiercely  for 
flesh  and  blood  to  endure,  there  is  at  hand  a  basin  containing 
water  and  a  small  mop  with  which  to  sprinkle  it  on  the  flames 
and  keep  them  in  check ;  hot  water  alone  is  allowed  to  quench 
the  patient's  thirst.  Those  whom  lack  of  merit  causes  to  die 
in  childbirth  are  buried,  not  cremated  as  is  the  rule  with 
nearly  all  others  who  die  in  Siam.  It  is  a  custom  almost  uni- 
versal on  the  entire  peninsula  of  Indo-China  and  Bangkok  ;  not 
only  the  Siamese,  but  the  Laos,  Burmese,  Malays,  and  others 
practise  it.  The  women  of  the  Combodians  improve  upon  the 
experience  of  those  of  other  nationalities,  for  they  place  theu' 


PREGNANCY,  PARTURITION,  AND    CHILDBED.  25 

couch  of  repose,  the  l)ench  of  bamboo  slats  on  which  they  lie, 
not  alongside  of,  but  actually  directly  over  the  fire,  so  that  the 
smoke  and  heat  ascending  do  their  full  work,  and  they  see 
their  thirty  days  and  nights  drag  slowly  along,  broiling  on 
this  Montezuma  bed  of  misery.  The  Mohammedan  Malays 
are  as  observant  of  this  custom  as  are  the  Buddhist  Siamese, 
so  that  it  does  not  seem  to  be  of  religious  origin.  Sir  John 
Bowing  suggests  there  may  be  some  vague  idea  of  pacification 
or  purification  connected  with  it  (certainly  purification).  There 
is  one  compensation  to  offset  the  mischievous  consequences  of 
this  practice:  it  makes  the  woman  of  that  land  escape  the 
evils  that  result  in  other  countries  so  often  from  resuming 
household  duties  too  soon  after  the  birth  of  the  child.  The 
Siamese  mother  is  guaranteed  by  this  custom  one  month  at 
least  the  fullest  liberty  and  undisturbed  rest  by  her  own  fire- 
side." ■ 

The  Binder^  which  is  now  gradually  passing  away  among 
civilized  people,  has  its  representative  among  some  of  the  sav- 
age races :  the  squaw  belt  is  used  among  most  of  the  Sioux 
tribes,  and  is  applied  by  them  during  confinement,  either 
before  the  expulsion  of  the  child  or  before  the  expulsion 
of  the  placenta,  and  is  worn  until  the  next  day.  It  is  a 
leather  belt  about  four  inches  wide  with  three  buckles.  The 
Kiowas,  Comanches  and  Wichitas  use  a  broad  bandage  of 
buckskin,  ornamented  with  beads,  which  they  buckle  tightly 
around  the  abdomen  of  the  mother  immediately  after  the  com- 
pletion of  labor,  and  this  bandage  is  thus  worn  for  about  a 
month.  Some  of  the  Sioux  tribes  use  a  broader  belt,  with  a 
compress  underneath,  which  is  worn  for  a  length  of  time.  The 
Klatsops  also  make  use  of  a  squaw  belt,  retaining  it  as  long  as 
convenient  to  the  wearer.  Of  some  of  our  Indians,  especially 
the  Yumas,  I  am  expressly  told  that  they  wear  no  bandage ; 
and  in  old  Calabar  a  handkerchief  simply  is  tied  around  the 
abdomen  and  twisted  so  as  to  make  it  more  like  a  cincture 
than  a  bandage ;  it  is  placed  right  over  the  hard  contracting 
womb.     In  Syria  the  regular  broad  bandage  is  worn. 

With  regard  to  the  thne  of  the  puerperium^  or  the  time  of 
rest  which  is  given  the  woman  in  childbed,  there  is  a  greater 

'Notes  on  Obstetric  Practices  in  Siam.  Samuel  R.  House,  M.D.,  Ar- 
chives of  Medicine  June,  1879. 


26  LABOR :^    AN  ETHNOLOGICAL   STUDY. 

variation  among  the  customs  of  the  different  tribes  and  people 
than  in  almost  any  other  feature  of  that  great  physiological 
function  of  woman.  Some  observe  no  period  of  rest,  but  re- 
sume their  ordinary  occupation  as  soon  as  they  have  had  their 
plunge  in  the  water  after  the  birth  of  the  child.  But  among 
many  people  there  is  a  certain  time  of  rest  and  isolation  which 
is  governed  more  particularly  by  their  religious  beliefs  of  their 
uncleanliness;  and  very  likely  some  wise  law-giver  infused  this 
idea  into  the  unwritten  laws  of  the  people,  with  the  view  of 
necessitating  a  period  of  rest  for  the  young  mother.  "We  find 
this  custom  as  far  back  as  we  have  record,  and  it  seems  that 
in  the  period  of  seven  and  of  thirty  days  the  two  periods  of 
childbed  are  exemplified,  first  that  of  the  lochia  rubra,  and  sec- 
ondly that  of  the  lochia  alba.  With  regard  to  the  first  period 
the  puerpera  should  be  as  unclean  during  the  time  of  the  bloody 
flow  as  she  is  during  the  menstrual  flow,  and  this  period  after 
the  birth  of  a  male  child  is  fixed  at  seven  days,  but  after  the 
birth  of  a  female  at  two  weeks.' 

Similar  beliefs  existed  among  many  ancient  people :  in 
Athens  the  puerpera  was  considered  unclean,  and  whoever 
touched  her  was  forbidden  to  visit  an  altar ;  even  the  midwife 
who  was  present  at  the  confinement  was  obliged  to  perform  a 
religious  cleansing  of  her  hands  at  the  feast  of  the  Amphidro- 
mies,  when  the  new-born  child  was  carried  about  the  family 
altar.  When  the  Isle  of  Delos  was  to  be  made  a  sacred  island, 
it  was  forbidden  that  a  confinement  should  take  place  within 
its  shores. 

It  is  evident  enough  why  the  ancient  Israelites  considered 
the  puerpera  unclean  during  the  first  days  after  childbirth,  but 
it  seems  difiicult  to  explain  why  this  uncleanliness  pliould  have 
lasted  seven  days  after  the  birth  of  a  male  and  fourteen  after 
that  of  a  female  child.  Kotelman  believes  that  it  was  because 
the  female  sex  was  considered  the  weaker,  the  most  despised, 
and  the  one  which  would  cause  the  most  uncleanliness.  It  is 
remarkable  that  among  the  Greeks  the  same  idea  was  preva- 
lent. 

In  the  second  period,  during  the  white  fiow,  the  puerpera 
was  obliged  to  remain  at  homo  for  thirty-three  days  for  a  boy 
and  sixty-six  days  for  a  girl  baby,  but  was  no  longer  consid- 
'  Kotelman:  The  Ancient  Hebrews. 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  27 

ered  unclean.  We  have  already  seen  that  some  of  our  Indians 
seek  to  cleanse  and  purify  themselves  by  frequent  steaming, 
others  by  washing,  and  the  Siamese  by  a  purification  of  fire 
through  a  period  of  thirty  days,  which  is  diminished  by  five 
days  for  each  succeeding  child.  According  to  other  state- 
ments, and  possibly  in  other  parts  of  Siam,  seven  days  of  this 
fiery  ordeal  suflice  to  purify  the  unfortunate  woman.  Among 
the  Kalmucks,  a  woman  is  regarded  as  unclean  for  three  weeks 
after  delivery,  but  never  is  she  permitted  to  remain  on  her  bed 
longer  than  seven  days.  The  northern  tribes  of  Russia,  the 
Samojedes  and  others,  consider  the  puerpera  unclean  for  several 
months  after  confinement ;  her  husband  is  very  careful  not  to 
approach  her,  and  she  remains  in  her  hut  isolated,  often  very 
badly  taken  care  of,  so  much  so  that  mother  and  child  may 
succumb  to  this  neglect ;  only  after  the  expiration  of  two 
months  is  she  herself,  and  the  tent  in  which  the  confinement 
took  place,  thoroughly  smoked,  and  from  that  time  on  con- 
sidered as  clean.  Ten  days  is  the  period  of  uncleanliness 
among  the  tribes  of  Alaska.  In  Egypt,  those  who  are  in  easy 
circumstances  remain  abed  for  three  to  six  days,  but  poor  wo- 
men resume  their  ordinary  oecupatious,  if  not  severe,  in  a 
day  or  two ;  in  Syria,  a  rest  of  about  six  days  in  bed  is  per- 
mitted. In  Japan,  the  puerpera  is  not  placed  in  the  usual  re- 
cumbent position,  but  sits  propped  up  by  pillows,  the  mat  upon 
which  she  was  confined  being  left  in  place.  In  this  upright 
position  the  woman  remains  for  about  three  days,  when  grad- 
ually the  prop  behind  is  removed,  till  finally  she  is  lying  with 
her  head  on  a  high  pillow,  and  at  the  end  of  three  weeks  she 
gets  up  and  the  customary  congratulatory  feast  is  given  to  the 
relations  of  the  family.  Another  authority  states  that  the 
patient  retains  the  recumbent  position  until  the  twenty-first 
day,  and  then,  if  all  has  gone  well,  takes  a  bath  and  resumes 
her  duties.  The  Yenadies  of  Southern  India  ordain  a  period 
of  isolation  of  ten  days,  after  which  the  mother  returns  to  her 
household  and  its  duties.  The  same  is  true  of  the  Yedas,  also 
of  Southern  India ;  the  first  five  days  after  confinement  are 
spent  by  the  puerpera  in  a  hut  within  call  of  the  Konan^  to- 
gether with  mother  and  sister  or  assistants ;  on  the  sixth  day, 
she  is  moved  to  a  shelter  nearer  to  the  Konan,  in  which  she 
remains  isolated  for  another  five  days.     After  the  tenth  day 


28  LABOR:    AN  ETHNOLOGICAL    STUDY. 

she  washes  with  warm  water  and  turmeric,  anointing  herself 
with  oil ;  washing  is  continued  for  one  month,  when  she  re- 
sumes work.  Dr.  Shortt  makes  a  similar  report  of  other 
tribes  of  Southern  India ;  he  says  that  the  woman  lives  in 
strict  seclusion  in  a  small  lodge  ten  or  twelve  paces  from  the 
family  home  for  thirty  days  after  childbirth,  frequently  wash- 
ing ;  before  joining  the  others  she  has  to  wash  all  her  clothes 
and  undergo  a  general  purification. 

The  Wakamba  of  Africa  put  their  parturient  to  work  four 
to  six  days  after  confinement.  The  Wa-zegua  alone  permit 
the  woman  to  rest  abed  for  fourteen  days.  Most  of  these 
tribes  also  purify  by  washing  with  hot  water.  The  Abyssin- 
ians  and  the  Somali  use  slack  lime.  The  women  of  the  Was- 
waheli  sometimes  insert  the  juice  of  a  lemon  into  the  vagina 
to  hasten  contraction.  The  Wakamba  ordain  a  coitus  about 
the  third  day,  and  after  this  the  puerpera  is  considered  clean. 
Among  some  of  the  African  tribes  the  women  carry  an  ebony 
staff  for  forty  days  after  confinement,  for  the  purpose  of  keep- 
ing off  the  devil. 

The  North  American  Indians  seem  to  be  less  careful  of  their 
women.  I  am  positively  informed  of  the  Sioux,  the  Santees, 
the  Apaches,  the  Indians  of  the  Neah-Bay  Agency,  as  well  as 
the  natives  of  Coram  and  of  the  Antilles,  and  the  Yuricaria 
of  Bolivia,  that  they  practically  observe  no  period  of  childbed, 
but  go  to  work  upon  the  same  day  or  the  day  after  that  of 
their  confinement.  Other  of  our  Indian  tribes  observe  a  cer- 
tain period  of  rest ;  those  of  the  Uinta  valley  take  up  their 
abode  in  the  ^'- wick-e-up'"'  in  which  they  are  confined,  and 
return  to  the  lodge  occupied  by  the  family  after  from  two  to 
four  weeks,  and  during  this  period  they  are  considered  to  a 
certain  extent  unclean.  The  women  of  the  Laguna  Pueblo 
remain  unwashed  and  in  bed  for  four  days;  very  early  on 
the  fifth  the  puerpera  is  washed  and  dressed  under  the  super- 
intendence of  a  Sheaine  or  priest,  who  walks  out,  followed 
by  the  women,  to  see  the  sun  rise  and  to  render  thanks 
!  for  her  safe  delivery.  As  she  walks  after  the  Sheaine  she 
tlirows  corn  blossoms  into  the  air  and  blows  them  around 
as  an  offering  of  thanks.  Thirty  days  after  the  child  is  born, 
the  woman  is  clean  and  her  husband  returns  to  her,  but  some 
prefer  to  wait  thirty-six,  and  others  forty  days.    A  good  many 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  29 

of  these  Indians,  however,  have  abandoned  the  fifth-day  su- 
perstition, the  sun  worship,  and  are  cleaned  or  washed  at  once 
and  get  up  as  soon  as  they  feel  able  to  go  about  their  work. 
The  native  Mexican  woman  remains  abed  three  days  ;  on  the 
tliird  day  she  gets  up  and  for  the  first  time  since  her  confine- 
ment changes  her  clothing.  The  lochial  discharge  is  usually 
abundant  and  continues  for  a  long  time,  seldom  less  than  forty 
days.  At  any  rate  it  is  only  after  a  period  of  forty  days  that 
the  woman  ventures  to  bathe  herself.  After  that  she  drinks 
freely  of  a  decoction  of  some  native  plant  for  the  purpose  of 
increasing  the  discharge  and  bringing  it  to  a  speedy  close. 

Yery  little  or  no  attention  is  paid  to  \\\q  food  which  women 
receive  after  childbirth^  yet  some  tribes  make  a  reasonable 
change  in  their  diet.  The  Kalmucks  feed  the  puerpera  mainly 
on  broth  during  the  first  days,  giving  her  but  very  little  mut- 
ton, the  quantity  of  meat  being  gradually  increased.  Among 
other  of  the  Russian  tribes,  as  I  have  already  stated,  the  isola- 
tion of  the  patient  is  so  complete  that  she  is  but  scantily  nour- 
ished and  glad  to  get  anything  she  can,  and  often,  together  with 
her  offspring,  suffers  actual  want.  In  Syria,  mutton  or  chicken 
broth  is  given  on  the  first  and  second  days,  then  carminative 
drinks,  cinnamon  tea  and  so  on,  for  six  days,  after  which  the 
quantity  of  food  is  gradually  increased.  In  Old  Calabar,  the 
patient  is  allowed  a  pot  full  of  chop,  which  her  husband  has 
prepared  during  the  labor,  to  be  given  her,  and  she  is  expected 
to  eat  a  quantity  of  it  immediately  after  confinement.  In 
southern  India,  the  natives  seem  to  pay  greater  attention  to  the 
diet  of  the  puerperal  woman  than  in  almost  any  other  country. 
Certain  of  the  native  tribes  live  for  three  days  after  delivery 
on  the  tender  leaf  bud  or  cabbage  of  a  kind  of  date  palm, 
Phoenix  sylvestris,  after  which  rice  or  other  food,  to  which 
they  are  accustomed,  is  partaken  of.  The  Dombergive  her  plain 
rice  on  the  first  day,  and  on  the  second  chillie  powder  and 
curry-pillay  is  mixed  with  the  rice.  Among  the  Kanikars  the 
puerpera  receives  as  a  tonic  for  the  first  day  a  kari  (ragout) 
seasoned  with  turmeric  pepper  and  tamarind. 

The  negroes  of  Africa,  as  a  rule,  make  very  little  change. 
The  Waswaheli  and  JNyassa  give  the  puerpera  food  highly 
seasoned  with  Cayenne  pepper  and  other  spices.  The  Wa- 
kamba,  like    the   natives    of    the   Andaman    islands,  make 


30  LABOR:    AN  ETHNOLOGICAL    STUDY, 

almost  no  change.  The  same  I  may  say  of  our  own  In- 
dians, with  the  exception  of  the  Yumas,  of  whom  I  see 
it  stated  that  the  puerpera  and  the  murderer  are  treated 
to  the  same  diet;  neither  are  allowed  to  eat  either  meat 
or  salt  for  one  month,  for  the  purpose  of  purification. 
The  Basuthos  treat  the  patient  cruelly  in  refusing  her  water 
for  three  days  after  confinement,  the  idea  being  probably  the 
fear  of  too  great  a  quantity  of  milk  oppressing  the  breast. 
The  Loango  woman  drinks  quantities  of  hot  water  for  several 
months  in  order  to  increase  the  flow  of  milk,  and  she  also 
washes  herself  with  a  decoction  of  the  leaves  of  Ricinus 
communis.  With  leaves  of  the  same  plant  steeped  in  water, 
the  genitals  are  rubbed  and  cleansed  until  the  secretion  ceases. 
The  young  mother,  moreover,  takes  a  great  many  baths  in 
some  secluded  spot  in  a  slight  excavation  made  in  the  ground 
and  laid  out  with  mats,  where  cold  and  hot  water  is  alternately 
poured  over  her  and  the  body  is  kneaded,  rubbed,  and  anointed. 
Of  the  medicines  used  in  the  puerperal  condition,  I  can  only 
learn  that  in  Mexico  teas  from  native  herbs  are  given  to  in- 
crease the  discharge  of  the  lochia ;  the  same  is  accomplished 
in  southern  India  by  the  use  of  saffron  and  neem  leaves.  In 
Syria,  carminative  drinks  are  given.  In  Siam,  hot  water  has 
eased  the  thirst  produced  by  the  parching  fire;  whilst  in  Africa 
it  is  given  to  increase  the  flow  of  milk.  Among  the  natives 
of  Russia  many  of  the  stronger  and  more  aromatic  herbs  are 
used  in  the  various  diseases,  and  many  methods  of  treatment 
are  resorted  to  in  mammary  aflfections,  which  seem  to  be  very 
common  in  the  puerperal  state,  as  the  remedies  are  so  numer- 
ous. I  will  mention  but  one,  on  account  of  its  peculiarity. 
In  case  of  hardening  of  the  breast,  the  patient  places  herself 
in  front  of  the  heated  stove  in  order  to  warm  the  diseased  part 
as  thoroughly  as  possible.  In  the  mean  time  some  other  per- 
son heats  a  woollen  sock,  which  has  been  moistened  with  the 
urine  of  the  patient,  places  it  as  hot  as  it  can  be  borne  upon 
her  breast  and  attempts  to  keep  the  breast  as  well  as  the  sock 
hot  and  moistened  with  urine ;  then  some  iron  utensil,  a  knife 
or  horse-shoe,  chilled  in  ice,  is  placed  upon  the  affected  breast. 
Tlic  liotter  and  more  moist  the  breast  is,  and  the  colder  the 
iron,  the  more  certainly  will  the  cure  be  effected.  I  will  not 
refer  to  any  of  the  cerem,onies  which  are  here  and  there  ob- 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  31 

served,  either  upon  the  birth  of  the  child,  especially  if  a  male, 
or  upon  the  return  of  the  mother  from  her  isolated  state,  when 
cleansed  and  purified,  to  her  home  and  her  family,  but  will 
simply  call  attention  to  a  remarkable  feature  common  to  the 
natives  of  the  coast  of  Borneo  and  to  some  of  our  Indians. 
For  instance,  among  the  land  Dayokas  of  Borneo  the  husband 
is  always  treated  badly  after  the  birth  of  the  child,  when  he  is 
dieted  on  rice  and  salt,  and  for  a  few  days  forbidden  to  bathe 
or  show  his  face  out  of  doors ;  whilst  among  some  of  our  In- 
dian tribes  the  father,  after  calling  his  relations  and  friends  to- 
gether and  having  a  feast  of  boiled  dog  and  other  Indian  deli- 
cacies spread  for  them,  goes  off  and  caches  himself  until  the 
child  is  a  week  old.  This  practice,  however,  is  only  observed 
by  the  young  men  who  are  so  ashamed  of  the  occurrence  that 
they  go  to  some  friend  and  stay  until  they  summon  sufficient 
courage  to  come  back,  when  the  wife  presents  the  child  for  the 
first  time  to  its  father.  The  management  of  the  puerperal 
stage  by  the  Indians  of  the  Pacific  coast  has  been  so  well  de- 
scribed by  Dr.  J.  Fields,  formerly  of  the  Grand  Ronde  Agency, 
Oregon,  that  I  will  quote  verbatim  that  part  of  his  letter  re- 
ferring to  this  subject.     He  says  : 

"The  treatment  resorted  to  is  not  alike  in  all  the  tribes; 
some  with  whom  I  have  come  in  contact  require  the  woman  to 
keep  on  her  feet  the  greater  part  of  the  day,  taking  short 
walks  around  the  camp  and  resting  only  when  she  becomes 
very  weary;  as  a  support  she  uses  a  staff,  an  instrument  through 
the  aid  of  which  relief  comes,  as  the  body  is  frequently  bent 
forward  which  brings  the  abdominal  walls  immediately  over 
the  uterus  against  the  upper  end  of  the  stick,  on  which  she 
also  holds  her  hand,  as  a  man  walks  with  a  cane ;  for  a  period 
of  three  or  four  days  the  woman  continues  the  prescribed 
walks,  with  an  occasional  hour  in  a  reclining  posture  to  rest 
her  feet ;  then  she  is  considered  well.  The  object  of  this,  as 
old  women  of  the  tribe  informed  me,  is  to  facilitate  the  flow 
of  the  lochia ;  they  think  that  should  the  woman  lie  in  bed 
the  blood  would  accumulate  in  the  abdominal  cavity  and  she 
must  die. 

From  all  I  can  learn  about  the  practice  of  the  Indians  here 
before  the  white  men  came  among  them,  their  procedure  in  the 
after-treatment  was  solely  for  the  purpose  of  encouraging  a 


32  LABOR:    AN  ETHNOLOGICAL    STUDY. 

free  flow  of  the  lochia,  and  I  hear  of  no  death  from  hemor- 
rhage. 

Those  tribes  of  Indians  on  the  Pacific  coast  who  follow  a 
different  course  of  treatment,  place  the  woman  on  a  bed  as 
soon  after  delivery  as  possible,  securely  wrap  her  in  a  blanket 
or  some  covering,  and  place  her  near  the  fire,  where  she  is  kept 
in  a  closely  wrapped  condition  to  escape  taking  cold  and 
having  fever ;  here  she  is  kept  for  four  or  five  days,  when  she 
at  once  takes  charge  of  the  babe  and  resumes  all  the  duties 
that  fall  to  the  lot  of  an  Indian  woman. 

During  two  and  a  half  years'  life  among  the  Indians  I  neither 
saw  nor  heard  of  a  case  of  puerperal  fever,  puerperal  eclampsia, 
or  any  diseases  peculiar  to  lying-in  women.  Neither  did  a 
death  in  labor  come  under  my  observation  ;  few  women  have 
any  mammary  trouble,  notwithstanding  their  being  exposed  to 
the  same  cause  that  is  a  prolific  source  of  mammary  complica- 
tion among  white  women." 

The  absence  of  mammary  trouble,  as  observed  by  Dr.  Field 
among  the  Indians  of  the  Pacific  coast,  is  true  of  most  peo- 
ples living  in  a  comparatively  natural  state,  as  the  chest  is 
either  exposed  or  only  loosely  draped,  so  that  the  gland  is 
not  irritated  by  closely  fitting  garments  ;  on  the  contrary,  it 
is  hardened  by  exposure,  the  muscular  and  glandular  system 
is  strengthened,  or  rather  allowed  to  develop  naturally  ;  the 
shape  of  the  breast  is  not  artificially  altered,  and  no  artificial 
support  is  given  it,  but  the  muscles  are  allowed  to  perform 
their  functions,  which  is  the  case  among  civilized  women 
only  during  the  period  of  nursing,  when  the  weakened,  atro- 
phied fibres  are  at  once  called  upon  to  perform  this  service  in 
case  of  a  temporary  hypertrophied  gland,  which  was  never 
asked  of  them  under  ordinary  circumstances. 

All  parts  of  the  organ  remain  more  fully  developed  and 
more  hardy,  less  liable  to  inflammation  than  among  those 
races  accustomed  to  the  laces,  straps  and  stays  of  civilization 
and  fashion. 

Among  some  of  these  people  peculiarly  situated,  such  as  the 
Arabs  (Corr^),  fissure  of  the  nipples  is  said  to  be  frequent, 
owing  to  a  lack  of  care  of  the  breasts  and  exposure  to  ex- 
ternal violence,  perhaps  to  the  irritating  sands  of  the  desert  : 
the  usual  consequences  follow — inflammation,  induration,  and 


PBEGNANCY,  PABTUBITIOX  AND  CHILDBED.  33 

even  degeneration  of  tlie  gland.  Thej  treat  the  fissure  with 
a  fine  powder  of  henna,  or  by  alum  powder  ;  in  the  Moorish 
villages  a  few  drops  of  orange  flower  essence  are  added  to 
this. 

Corr^  observes  a  fact,  well  known  in  this  Mississippi  Val. 
ley,  that  the  breasts  in  lactation,  just  as  the  uterus  in  its  condi- 
tion of  activity  in  pregnancy  and  in  the  puerperium  can,  allow 
a  local  center  for  malarial  irritation  ;  malaria  is  as  much  at 
home  in  the  vast  valleys  and  deltas  of  the  great  rivers  of 
Asia  and  Africa  as  it  is  in  our  own  Mississippi,  and  milk 
fevers  with  malarial  types  are  frequently  observed,  and  yield 
as  readily  to  quinine  among  the  Negroes,  Hindoos  or  Arabs 
as  among  our  own  people. 

As  our  civilization  suffers  in  comparison  with  the  primi- 
tive state  in  so  many  of  the  features  of  generation,  so  it  does 
in  the  nursing  of  the  new-born.  One  sentence  in  La  Mere 
et  I'Enfant  tersely  states  a  very  sore  point  ;  he  truly  says  : 
"Among  all  people  except  the  most  civilized  the  mother's 
milk  is  considered  the  proper  nourishment  for  the  children." 

The  husband,  at  all  other  times  the  lord  and  master,  is 
placed  in  rather  a  peculiar,  sometimes  ludicrous  position,  as 
Vv'e  have  just  related,  among  certain  peoples;  if  ever,  it  is  dur- 
ing the  period  of  recent  maternity,  in  child-birth  and  child- 
bed, that  a  certain  amount  of  regard  is  involuntarily  paid  the 
wife  by  savage  peoples,  and  I  would  take  issue  with  Corre,^ 
wdio  claims  that  the  exclusion  of  men  from  the  lying-in-room 
is  not  the  result  of  modesty.  He  says:  "Our  feeling  of  shame 
and  modesty  is  a  refinement  entirely  unknown  to  many  peo- 
ple, and  shown  by  others  in  the  most  peculiar  ways.  A- 
mong  many  a  woman  in  labor  can  only  be  attended  by  one 
of  her  own  sex;  this  is  because  among  savagec  woman  is 
a  most  inferior  being,  despised  and  dare  not  aspire  to  the 
assistance  of  men.  She  is  worth  so  little  and  so  easily  re- 
placed; she  is  good  for  the  bearing  of  children,  to  look  after 
them,  and  to  give  satisfaction  to  her  master,  but  especially  to 
do  the  rough  work  in  the  fields.  As  soon  as  she  is  a  nuisance 
she  is  left,  she  is  sold,  she  is  killed,  and  sometimes  she  is  eaten 
for  fear  of  letting  a  good  piece  of  meat  escape." 

i  La  Mere  et  I'Enfant  dansles  Races  Humaiaes,  faris,  1882. 


34  LABOIi:  AN  ETHNOLOGICAL  8TUDY. 

During  tliis  tiding  period  at  least  a  better  feeling  prevails, 
as  is  proven  by  many  of  the  instances  related ;  and  Corre  him- 
self, in  his  extremely  valuable  and  interesting  work,  tells  us 
how  the  sufferings  of  the  parturient,  in  Old  Calabar,  are  con- 
cealed by  the  laughter  and  conversation  of  surrounding  rela- 
tives, that  not  a  cry  be  heard,  as  it  would  dishonor  her  and 
cause  the  family  to  repudiate  her;  at  the  same  time  the  hus- 
band is  clothed  like  a  woman,  put  to  bed  and  sighs  terribly, 
as  if  he  was  enduring  great  suffering. 

A  similar  custom  formerly  existed  in  Greenland  and  still 
prevails  in  Guiana,  among  certain  Canadian  tribes  and  the 
Caribeans:  while  the  woman  who  has  been  delivered  attends 
to  her  household  duties  in  the  interior  of  the  house,  her  hus- 
band goes  to  bed  and  receives  in  her  place  the  visits  of  con- 
dolence from  friends  and  relatives.  Among  the  ancient  Cor- 
sicans  a  similar  custom  existed,  and  is  still  observed  in  our 
day  in  some  of  the  regions  of  the  Pyrenees.  It  is  also  found 
among  certain  African  tribes. 

This  peculiar  comedy  is  doubtless  for  the  purpose  of  caus- 
ing the  woman  to  forget  her  trouble  and  give  her  an  innocent 
revenge  for  the  suffering  which  she  alone  has  supported  in  the 
work  of  reproduction. — (Corre.) 

It  certainly  does  appear  to  be  a  certain  acknowledgement 
of  her  fortitude  and  suffering,  and  shows  a  certain  amount  of 
respect,  however  passing  it  may  be. 

I  have  treated  more  particularly  of  the  puerperium  among 
the  red  races,  and  will  add  some  interesting  facts  from  the 
work  above  referred  to. 

In  the  Antilles  and  Guiana  hemorrhages  are  severe,  pro- 
lapses frequently  caused  by  brutal  intervention  of  the  negroes. 
As  soon  as  delivery  is  effected  food  is  offered,  meat  or  some 
mixture  of  milk,  palm  oil  and  tamarind,  and  after  a  few 
hours  the  usual  labors  in  the  house  are  again  taken  uj),  with- 
out going  outside  during  six  or  seven  days. 

In  China  more  pains  are  taken,  but  with  little  more  under- 
standing; the  patient  is  put  to  bed  but  not  permitted  to 
sleep,  because  this  might  weaken  her  and  prevent  the  proper 
circulation  of  the  blood.     She  must  rest  upon  a  high  bed,  lie 


PREGNANCY,  PARTUBITION  AND  CHILDBED.  35 

upon  her  side,  the  knees  bent,  and  take  a  cup  of  the  nrine  of 
a  child;  during  the  first  three  days  she  must  take  three  or 
four  times  a  day  a  mixture  of  whiskey  and  child's  urine,  tak- 
ing care  not  to  take  too  much  whiskey.  Pork  slie  must  not 
take  for  six  days,  and  no  eggs  for  a  month,  because  they  might 
disturb  the  vessels. 

Many  peoples  have  a  superstitious  faith  in  the  use  of  heat 
immediately  after  confinement,  some  instances  of  which  I 
have  already  cited  :  so  among  the  Rouconyennes  a  steam 
bath  is  taken  in  a  hammock  under  which  a  large  stone  heated 
by  the  fire  is  placed ;  upon  this  water  is  thrown.  In  a  few  hours 
the  usual  occupations  are  again  taken  up.  When  the  Anamite 
is  delivered  a  vessel  filled  with  hot  coals  is  placed  under  her 
bed,  and  the  fire  kept  going  night  and  day;  the  stomach  is 
rubbed  twice  a  day  with  a  vessel  filled  with  hot  coals.  Dry 
food  is  given,  spiced  and  very  dry.  At  the  door  of  the  house, 
at  the  end  of  a  long  pole,  a  pot  of  charcoal  is  placed  as  a  sign  of 
labor,  and  that  the  entry  is  forbidden  to  such  whose  labors  have 
been  difiicult  or  followed  by  death;  when  the  lighted  end  of 
the  charcoal  is  turned  towards  the  interior  of  the  house,  a  boy 
is  born;  if  turned  outwards,  a  girl  is  born.  It  is  a  custom 
throughout  Annam  that  the  puerpera  must  take  a  medicine 
consisting  of  a  decoction  of  laxatives  and  purgatives.  Dur- 
ing the  month  of  her  child-bed  her  husband  abstains  from  all 
work,  and  must  give  all  his  care  to  his  wife  and  child  and  to 
make  the  necessary  preparation  for  this.  The  mother  cannot 
leave  the  house  before  four  weeks,  and  in  order  to  preserve 
her  from  the  evil  influences  of  the  air  she  is  bandaged,  head 
and  feet,  with  saffron.  In  Siam  the  woman  is  placed  before 
the  fire  after  delivery,  and  if  you  ask:  where  is  so  and  so,  the 
answer  is  given:  nhe  is  before  the  fire. 

The  Hindoo  woman  suffers  likewise;  when  labor  is  over  she 
is  placed  in  a  small,  ill  ventilated  room,  without  any  other 
opening  except  the  door,  which  is  usually  closed,  and  smoked 
by  a  wooden  fire,which  is  constantly  kept  up,  and  condemned 
to  isolation  in  a  terrible  atmosphere  ;  she  is,  moreover, 
obliged  to  abstain  from  food  :  during  the  first  three  days  she 
must  take  a  powder  composed  of  stimulating  spices,  and  dur- 


36  LABOB  :  AN  ETHNOLOGICAL  STUDY. 

ing  the  next  three  days  the  same  spices  with  certain  substances 
boiled  in  water  in  the  form  of  a  paste;  at  the  eleventh  day 
only  does  the  woman  begin  to  live  somewhat  like  the  rest  of 
the  family,  but  she  does  not  leave  the  room  for  a  month. 

This  frequent  resort  to  fire  seems  to  arise  from  an  instinc- 
tive idea  to  protect  the  puerpera  from  cold,  but  it  certainly  is 
beneficial  in  so  far  as  it  allows  her  a  certain  period  of  re&t, 
and  may  it  not  hasten  uterine  contraction  and  prevent  hem- 
orrhage? The  amount  of  heat  applied  is  at  least  equal  to 
that  of  hot  water,  which  we  now  resort  to  for  the  purpose  of 
arresting  hemorrhage. 

However  little  apparent,  good  reasons  exist  for  many  of 
these  seemingly  ludicrous  customs,  and  good  results  often 
follow;  harmful  as  they  appear  to  us,  they  are  probably  ne- 
cessitated by  the  peculiar  customs  of  the  people,  and  greater 
havoc  among  them  would  follow  their  neglect. 

Management  of  the  Child. 

The  management  of  the  new-horn  child  is  so  intimately 
connected  with  the  treatment  of  the  mother  in  the  puerperal 
state  that  the  subject  would  not  seem  complete  without  a  brief 
consideration  of  the  treatment  of  the  babe.  Although  the 
savage  mother  is  not  wanting  in  love  for  her  offspring,  the 
treatment  of  the  child  from  the  very  first  moment  is  one  well 
suited  to  fit  it  for  the  hardships  of  its  future  life.  Even 
among  those  people  where  kindness  is  shown  the  little  stranger, 
where  he  is  well  cared  for,  and  not  left  to  starve  in  isolation 
with  the  mother,  as  among  some  of  the  Russian  tribes,  he  re- 
ceives at  once  a  hint  of  the  exposure  to  which  he  may  be  sub- 
jected in  the  future.  As  an  ancient  chronicle  and  "  Early 
History  of  Virginia"  says,  in  speaking  of  the  original  inhab- 
itants of  that  country  :  "  The  manner  in  which  tliey  treat  their 
young  children  is  very  strange,  for  instead  of  keeping  them  warm 
at  their  first  entry  into  the  world,  and  wrapping  them  up  in  I 
don't  know  how  many  cloths,  according  to  our  fond  custom, 
the  first  thing  they  do  is  to  dip  the  child  over  head  and  ears 
in  cold  water,  and  then  to  bind  it  naked  to  a  convenient  board, 
having  a  hole  fitly  placed  for  evacuation,  but  they  always  put 
cotton  wool  or  other  soft  things  for  the  body  to  rest  on  between 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  37 

the  child  and  the  board.     In  this  posture  they  keep  it  several 
months,  till  the  bones  begin  to  harden,  the  joints  to  knit,  and 
the  limbs  to  grow  strong.     Then   they  loosen   it   from   the 
board,  and  suffer  it  to  crawl  about,  except  when  they  are  feed- 
ing or  playing  with  it.     While  the  child  is  thus  on  the  board, 
they  either  lay  it  flat  on  its  back,  set  it  leaning  on  one  end,  or 
hang  it  up  by  a  string  fastened  to  the  upper  end  of  the  board, 
the  child  and  board  being  all  the  while  carried  about  together. 
As  our  women  undress  their  children  to  clean  and  wash  their 
linen,  so  they  do  theirs  to  wash  and  grease  them.     The  method 
the  women  have  of  carrying  their  children  after  they  are  suf- 
fered to  crawl  about  is  very  particular.     They  carry  them  at 
their  backs  in  summer,  taking  one  leg  of  the  child  under  their 
arm,  and  the  counter-arm  of  the  child  in  their  hand  over  the 
shoulder,  the  other  leg  hangs  down,  and  the  child  all  the  while 
holding  fast  with  its  other  hand.     But  in  winter  they  carry 
them  in  the  hollow  of  their  match-coat  at  their  back,  leaving 
nothing  but  the  child's  head  out."     The  child  is  tucked  away  in 
an  equally  peculiar  manner  by  some  of  the  Polar  tribes  of 
Russia ;  until  it  begins  to  crawl  it  is  placed  in  a  fur  sack,  and 
carried  by  a  strap  about  the  mother's  forehead.     Later  it  is 
sewed  up  in  a  fur  garment  of  one  piece ;  for  the  sake  of  clean- 
liness  a   doorway  is   left   in  the  posterior  portion,  which  is 
opened  from  time  to  time  as  necessity  demands,  but  the  gar- 
ment is  not  once  removed  or  changed  until  outgrown  by  the 
child. 

Among  the  Sioux,  Crows,  Creeks,  and  other  of  our  Indians, 
the  mother  plunges  into  tlie  stream  with  her  child  immediately 
after  delivery,  or,  if  no  running  water  is  at  hand,  at  least  dips 
the  child  in  cold  water  as  soon  as  it  is  born ;  saltwater  is  used 
by  some  people  who  live  upon  the  sea  shore,  also  by  the  Kal- 
mucks, who  wrap  the  child  in  furs  as  soon  as  it  has  had  a  salt- 
water bath.  A  cold-water  bath  seems  to  be  the  customary 
initiation  of  the  new-born  child  into  the  troubles  of  this  world; 
it  is  the  case  among  most  of  the  Negro  tribes,  among  the  peo- 
ple of  Bolivia,  of  Ceram,  and  of  the  Andaman  Islands,  and  in 
some  parts  of  India ;  in  others,  in  Southern  India,  for  instance, 
the  child  is  washed  ia  tepid  water ;  so  also  in  Syria,  and,  as  a 
rule,  by  those  people  who  are  advanced  in  civilization. 

Usually  the  child  is  bathed  immediately  after  delivery,  but 


38  LABOR:    AN  ETHNOLOGICAL    STUDY. 

in  Southern  Arabia  at  least  two  hours  are  permitted  to  pass 
by,  during  which  the  child  is  wrapped  in  soft  warm  cloths, 
then  it  is  washed  and  anointed.  This  is  also  the  custom  of 
numerous  African  tribes,  some  waiting  for  several  hours, 
others  performing  the  ceremony  at  once;  some  use  fat, 
others,  such  as  the  Wakamba,  Somal,  "Wanika,  and  other  tribes 
use  fresh  butter.  The  Masai  and  the  Waswaheli  throw  a 
slightly  acid  and  astringent  powder,  made  from  the  fruit  of 
the  adansonia  tree,  over  the  child,  to  facilitate  cleansing,  just 
as  we  use  oil  or  fat.  The  Cheyennes  and  Arapahoes  envelop 
the  child  as  soon  as  it  is  born  in  dry  horse  manure,  and  do  not 
wash  it  for  several  days.  The  Umpquas  wrap  it  in  dirty  rags, 
and  also  put  it  away  without  washing.  In  India,  in  Africa, 
and  among  the  American  Indians,  there  are  many  tribes  who 
bathe  their  children  for  at  least  one  year.  In  Syria,  in  India, 
and  in  Africa,  there  are  many  who  anoint  the  children  regu- 
larly, often  after  every  bath,  and  great  attention  is  paid  to  the 
kneading  and  stretching  of  the  limbs  and  joints,  with  the  view 
of  making  the  child  straiglit  and  strong,  and  stimulating  the 
healthy  development  of  the  muscles.  Some  strap  the  child 
or  have  various  methods  of  bundling  it,  so  as  to  carry  it 
conveniently.  Some,  like  the  Chinooks,  of  Oregon,  compress 
the  head  to  shape  it  in  a  peculiar  way.  This  method  of 
kneading  and  stretching  the  child  is  well  described  in  a  paper 
on  the  inhabitants  of  the  Andaman  Islands  {Zeitschft.  fur 
Eihnologie^  1 877,  p.  51),  There  it  is  usually  done  by  the  father, 
who  warms  the  palm  of  his  right  hand,  presses  firmly  upon 
the  temples  and  upon  the  base  of  the  nose,  "whilst  the  left  hand 
fixes  the  lower  jaw ;  tlien  the  wrists  and  elbows  and  the  septum 
of  the  nose  are  compressed  between  the  thumb  and  index  fin- 
ger, and  so  on  quite  a  number  of  manipulations  are  performed. 
It  is  interesting  to  see  that  the  same  variations  exist  in 
regard  to  their  customs  as  to  the  time  of  applying  the  child 
to  the  hreast  which  we  find  among  civilized  people.  Thus 
among  the  Kanikars  and  several  other  tribes  of  Southern 
India  the  child  is  applied  at  once  to  the  breast,  as  is  done  by 
some  of  our  Indians.  In  Alaska  it  is  customary  to  suckle  the 
child  as  soon  as  it  has  vomited  for  the  first  time ;  among  the 
Kalmucks  the  new-born  is  given  a  piece  of  raw  mutton  to  suck, 
and  is  not  permitted  to  take  the  breast  for  several  days.  Upon 
the  Andaman  Islands  it   is  customary  for   any  neighbor  or 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  39 

friend  who  is  suckling  to  nurse  the  new-born  child  for  a  day 
or  two  until  its  mother's  milk  appears.  In  Southern  India, 
the  child  is  fed  on  boiled  honey  until  the  third  day,  and  not 
until  then  is  the  mother  allowed  to  suckle  it.  In  Transvaal,  a 
soft  mush  is  fed  to  the  child  for  the  first  three  days,  and  in 
Loango  the  same  custom  prevails,  and  the  people  seem  to  know 
the  Qualities  of  colostrum,  at  least  they  make  a  difference  be- 
tween the  milk  of  the  first  days  and  that  which  afterwards 
serves  for  the  nourishment  of  the  child.  The  negroes  of 
Loango  hold  a  suckling  child  just  as  the  Caucasian  mother 
does,  and  it  seems  that  the  breast  is  only  given  at  certain  times. 

As  regards  the  perioil  of  suckling,  the  time  seems  to  vary 
greatly,  yet  it  is  governed  by  about  the  same  circumstances 
among  all  primitive  people  as  it  is  among  our  Indians.  As  a 
rule,  the  child  is  nursed  as  long  as  the  mother's  milk  lasts,  or 
until  another  conception  takes  place  ;  at  all  events,  the  chil- 
dren are  nursed  unreasonably  long.  Thus  the  Kanikars  suckle 
the  child  for  three  to  five  years ;  the  inhabitants  of  the 
Sierra  Leone  often  until  the  child  can  walk ;  those  of  Aus- 
tralia, from  one  to  three  years,  according  to  circumstances ; 
the  Alaskans,  from  ten  to  thirty  months ;  the  Tartars  and 
Esthonians,  for  a  very  long  period,  not  only  limited  as  it  is 
among  our  Indians  by  another  conception,  but  they  suckle  the 
child  until  the  next  confinement  forces  them  to  make  room  for 
a  younger  offspring.  The  Arabians  seem  to  nurse  for  a  period 
of  perhaps  two  years;  the  Waswaheli,  from  one  to  two  years; 
in  the  eastern  portions  of  Africa,  it  is  the  custom  to  nurse  as 
long  as  the  mother's  milk  will  last,  and  often  during  the  next 
pregnancy.  A  child  which  is  nursed  during  such  a  period  is 
called  an  external  twin. 

For  the  purpose  of  weani)ig  the  child,  it  is  customary  in 
Southern  Arabia  to  smear  myrrh  or  asafetida  upon  the  nip- 
ple. The  Somal  use  the  fresh  juice  of  aloe  leaves  for  the  same 
purpose,  and  in  Zanzibar,  cayenne  pepper  or  the  gum  of  the 
aloe  is  applied.  In  case  that  the  breasts  are  inflamed  during 
the  process  of  weaning,  the  natives  of  Southern  Arabia  press 
out  the  accumulated  milk  and  cover  the  breasts  with  a  poultice 
of  soft  mud  or  clay. 

I  have  already  remarked  that  insufticient  or  inferior  yb(96? 
is  frequently  a  source  of  injury  to  the  puerperal  woman  when 
isolated  during  her  period  of  uncleanliness,  as  it  is  often  the 


40  LABOR:    AN  ETHNOLOGICAL    STUDY. 

cause  of  sickness  and  death  of  the  child.  This  is  especially  the 
case  among  some  of  the  Russian  tribes.  Convulsions  occur 
frequently  among  the  children  who  are  partially  fed  with  heavy 
bread  which  has  been  first  chewed  by  the  mother ;  then  berries 
of  various  kinds  aj-e  given  the  infants,  not  even  always  ripe  ; 
they  are  kept  in  a  filthy  condition,  and  take  frequent  colds  by 
the  use  of  the  steam  baths  so  common  among  those  people. 
Coarse  food  and  constitutional  syphilis  are  the  causes  of  early 
death  among  many  of  the  Tartars.  In  Alaska,  the  fat  of  some 
sea  animal  is  the  first  food  which  is  given  the  infant.  The 
Masai  and  several  other  tribes  of  Africans  put  a  little  fresh 
butter,  which  is  especially  prepared  for  this  purpose,  into  the 
child's  mouth  after  the  second  day.  Among  the  "Wakikuyu  the 
child,  after  the  tenth  day,  receives  chewed  bananas,  which 
have  been  mixed  with  the  saliva  of  the  mother,  in  addition  to 
,the  butter.  The  "Wakamba  give  the  infant,  very  soon  after 
birth,  a  little  mush,  and  the  Somal  make  them  take  a  little  of 
the  juice  of  the  myrrh  daily  after  the  sixth  month  has  been 
reached.  In  case*  of  the  death  of  the  mother,  the  Wakikuyu 
and  "Waswaheli  raise  the  child  upon  goat's  milk  ;  other  tribes 
employ  nurses,  others  feed  the  child  upon  mush  and  other  food 
common  among  them.  The  Kossacks  think  wine  a  necessary 
addition  to  the  food,  even  of  suckling  infants.  In  Siam,  honey 
and  rice-water  is  given  from  the  first  days,  and  the  soft  pulp  of 
the  banana  is  crammed  into  the  little  mouth.  Dr.  Shortt  tells 
us  that,  in  Southern  India,  the  child  is  fed  on  boiled  honey 
after  the  third  day,  when  the  mother  is  allowed  to  suckle  it, 
and  if  the  external  parts  are  cold,  five  drops  of  the  railk  hedge 
{Euphorbia  Firucallt)  are  given  it.  On  the  third  day,  it  is 
rubbed  with  sweet  oil,  bathed  in  warm  water,  and  half  a  pie- 
weight  of  garlic,  one-quarter  pie-weight  of  black  pepper  heated 
in  a  kin-weight  of  castor  oil  is  given,  and  repeated  every  sec- 
ond day.  Some  give  castor  oil  every  morning  for  the  first, 
once  a  day  for  the  second,  and  every  other  day  for  the  third 
month.  From  the  third  day  the  mother  suckles  the  child  ;  if 
unable  to  do  so,  it  is  brought  up  on  goats',  cows',  or  asses'  milk. 
The  Villees,  another  of  the  tribes  of  Southern  India  (Trans- 
acts. London  Ethnolog.  Soc,  1865,  III.),  give  the  child  for  the 
first  two  or  three  days  a  preparation  of  black  pepper,  neem 
bark,  jaggery,  garlic  and  onions,  several  pots  full  of  which  are 
made  at  once  and  slowly  dished  out.     In  Old  Calabar,  the  child 


PREGNANCY,  PARTURITION,  AND   CHILDBED.  41 

is  first  rubbed  over  with  fine  sand,  then  with  soap  and  water; 
the  acid  juice  of  an  Aininoinum  is  squeezed  into  its  mouth,  and 
a  supply  of  tepid  water  follows,  and  for  the  first  three  days, 
during  which  it  is  not  allowed  to  suck,  it  gets  nothing  but 
water,  and  later,  although  the  mother  has  an  abundance  of 
milk  and  the  child  is  well  able  to  suck,  a  large  quantity  of 
water  ;s  given  at  least  once  a  day.  Every  morning  whilst  the 
child  is  washed,  water  is  thrown  into  its  mouth  continually  for 
several  minutes,  the  child  gasping  and  struggling.  This,  they 
say,  is  done  to  distend  the  abdomen  and  make  it  capacious  to 
take  plenty  of  food,  to  hasten  growth.  If  the  mother  is  away, 
the  cliild  is  kept  quiet  by  filling  with  water,  and  they  deem 
this  cheap  liquid  very  useful  in  this  respect;  although  too 
much  water  is  rarely  taken,  it  may  prove  injurious,  and  possi- 
bly the  enlarged  spleen,  which  is  very  common  among  children 
in  this  country,  and  not  among  adults,  may  be  traced  to  the 
over-dose  of  water. 

The  Kanikars  begin  to  give  rice-water  the  third  month.  The 
child  which  is  nursed  from  three  to  five  years,  gradually,  from 
the  third  month  on,  receives  other  food,  but  it  is  not  until  its 
seventh  year  that  it  eats  with  the  rest  of  the  family.  The 
Vedas  simply  suffer  the  child  to  die  if  the  mother's  milk  does 
not  suffice,  as  no  other  woman  dare  nurse  it,  and  cow's  milk 
rarely  succeeds.  After  the  daily  bath,  the  babe  is  anointed 
with  oil  and  turmeric,  and  rubbed  and  kneaded  in  accordance 
with  certain  rules,  as  we  have  related  of  other  tribes. 

Just  as  adults  are  treated  with  the  herbs  of  the  country  in 
their  various  diseases,  so  the  children  are  made  to  put  up  with 
them.  Teething  is  furthered  in  Russia  by  the  use  of  the  fresh 
juice  of  the  lemon  sweetened  with  sugar,  or  the  gums  of  the 
child  are  smeared  with  the  blood  which  comes  from  the  comb 
of  a  black  rooster  which  has  been  repeatedly  scratched  and  irri- 
tated with  a  comb.  In  case  of  restlessness,  a  decoction  of 
poppy  seed  is  given  the  cliild  after  it  has  been  carried  to  the 
ordinary  roosting-place  of  the  chickens  and  kept  there  for  a 
while.  In  case  of  convulsions,  a  decoction  of  Getitiana  pneu- 
wiowawMe  or  the  root  of  YalerianapTieG\^v&Q^.  The  powder 
of  Origanum^  starch,  or  lint  is  applied  in  case  of  soreness  of 
the  skin,  and  there  are  many  other  equally  efficacious  reme- 
dies in  use,  many  of  them  most  amusing  and  of  extreme  interest 
to  the  ethnologist,  but  beyond  this  of  little  or  no  value. 


42  LABOB:  AN  ETHNOLOGICAL  STUDY. 

These,  and  many  other  practices  and  remedies  which  I 
have  described,  are  peculiar,  many  are  more  or  less  effica- 
cious, most  of  them  harmless,  few  injurious  :  some  are  amus- 
ing— I  can  safely  say  amusing  in  speaking  of  such  simple, 
ignorant  people,  but  they  should  not  be  too  severely  con- 
demned for  their  child-like  beliefs,  and  we  can  little  afford 
to  cast  ridicule  \\])oi\  them  if  we  reflect  but  a  moment  upon 
the  many  equally  silly  remedies,  still  firmly  believed  in  by  so 
many,  in  the  midst  of  our  boasted  civilization  and  the  won- 
derful development  attained  by  medical  science.  Every  phy- 
sician, to  his  intense  disgust,  now  and  then  meets  with  the 
wonderful  concoctions  or  mystic  devices  of  some  sage  and 
knowing  old  dame,  who  confides  them  to  her  suffering 
friends  :  teas  and  herbs  innumerable  ;  an  onion  carried  in 
the  pocket  until  shriveled  to  cure  a  corn  ;  half  a  potato  care- 
fully buried  in  the  ground  to  destro}^  warts  ;  a  sheet  of  paper 
worn  upon  the  chest  for  the  relief  of  rail-road  sickness.  In 
Germany,  whilst  stationed  in  a  small  village  as  surgeon 
during  the  Franco-Prussian  war,  I  was  called  by  a  wealthy 
family  to  see  the  driver,  who  was  lying  abed,  suffering  in- 
tensely from  a  fall  from  a  tree,  with  possible  fracture  of  the 
femur. 

Unwillingly  he  submitted  to  an  examination;  but  although 
a  devoted  family  servant,  the  authority  of  his  mistress  was  not 
sufficient  to  force  him  to  follow  any  of  my  directions,  and 
njjon  returning  on  the  following  day  I  found  that  a  shej)herd 
had  been  called  from  a  village  miles  away.  Peasants  from 
near  and  far  sought  the  advice  of  this  shepherd,  who  had  in- 
herited his  gifts  from  his  father  and  grandfather,  who  had 
been  shej^herds  before  him,  and  had  practiced  the  healing  art. 
A  red  string  had  been  tied  about  the  contused  limb,  and 
within  a  certain  time  this  was  to  be  removed  and  the  broken 
limb  would  be  healed  !  Fortunately  it  was  but  a  contusion, 
and  the  man  suffered  no  serious  consequences. 

Prayers  to  certain  saints  will  cure  sterility  :  others  heal 
broken  and  rheumatic  limbs  :  the  chapels  sacred  to  particular 
saints,  in  the  churches  of  Italy,  Spain,  many  parts  of  France 
and  southern  Germany,  are  frequently  decorated  with  splints, 


PEEQNANCY,  PABTUEITIOX  AXD  CHILBED.  43 

crutches  and  other  appliances  used  by  the  sick,  which  have 
been  thrown  aside  by  the  -suffering  owners,  and  there  pre- 
served as  a  token  of  gratitude  to  the  saint  by  whose  inter- 
cession they  have  been  cured.  Other  cures  are  performed  by 
the  relics  of  saints,  by  miraculous  waters  ;  we  all  remember 
the  waters  of  Lourdes,  and  the  intense  excitement  created  by 
their  wonderful  qualities;  among  others  their  healing  powers, 
for  which  they  were  sought  by  innumerable  pilgrims. 

In  ]^[ew  Caledonia  the  sterile  woman  buys  from  the  medi- 
cine man  some  shapeless  puppet,  destined  to  share  her  couch 
and  to  exert  its  influence  in  favor  of  her  pregnancy  ;  in  Brit- 
tany (Corre)  a  statue  of  Saint  Quignole  still  exists,  in  front 
of  which  such  women  as  are  desirous  of  children  are  accus- 
tomed to  strike  their  stomachs.     "Whom  shall  we  ridicule  ? 

These  simple  people  have  many  laughable  customs — so  have 
we,  in  the  midst  of  this  era  of  enlightened  progress — but 
many  of  the  curative  means  adopted  by  primitive  people  are 
so  simple,  sound  and  rational,  that  we  learn  to  respect  them 
and  to  study  their  methods  with  more  than  idle  curiosity: 
thus,  among  the  Arabs  the  colicky  baby  is  given,  not  some 
narcotic  soothing  syrup,  but  oil,  or  the  breast  of  a  neighbor 
who  is  in  better  condition,  until  mother  and  child  have  im- 
proved ;  in  India,  where,  as  well  as  in  all  southern  climates 
spasmodic  nervous  affections  are  frequent,  especially  tetanus 
neonatorum,  the  entire  body  of  the  child  is  thoroughly  anoint- 
ed for  nine  days  after  birth  with  an  oily,  greasy,  substance,  in 
order  to  avoid  the  evil  effects  ot  cold  air  or  sudden  atmos- 
pheric change  ;  to  escape  these  dangers  they  also  cover  the 
umbilical  with  a  certain  adhesive  plaster,  after  cutting  the 
cord. 

Every  people  has  its  own  idea  of  beauty,  and  in  accord- 
ance with  this  they  endeavor  to  mould  the  body  of  the  new- 
born :  his  head  is  flattened,  his  nose  slit  or  the  ears  elon- 
gated, to  conform  to  the  aesthetic  views  of  the  particular  people. 

The  Flathead  mother  begins  to  compress  the  yielding 
cranium  of  the  infant  from  the  very  first,  that  he  attain  the 
type  of  beauty  which  is  the  standard  of  this  particular  tribe 
of  Indians.     Similar  customs  j^revailed  among  the  ancient 


44  LABOB:  AN  ETHNOLOGICAL  STUDY. 

Peruvians,  where,  however,  a  high,  conical  skull  was  pro- 
duced, as  well  as  the  flat  and  narrow  long  head.  Among 
the  Caraibes,  and  upon  some  of  the  Polynesian  islands,  the 
custom  still  prevails. 

The  Oriental  races  prefer  a  well  rounded  head,  as  shaped 
by  a  tightly  encircling  band,  so  as  better  to  fit  the  turban. 
The  Arabs  give  a  globular  form  to  the  head  of  the  new-born 
by  compressing  and  kneading  the  lateral  regions,  from  below 
upward,  with  the  palm  of  the  hand.  Even  in  France  the 
remnants  of  a  similar  custom,  which  but  recently  was  prac- 
ticed in  Normandy,  still  exist  ;  it  is  the  high,  circular  oon- 
striction  of  the  child's  head  formerly  also  found  in  the 
vicinity  of  Toulouse. 

The  Chinese  mother  of  the  upper  classes  begins  early  to 
compress  the  feet  of  her  girl  baby,  that  their  diminutive 
proportions  may  enforce  her  claims  to  beauty  and  society 
fame.  "  The  result  of  this  persistent  pressure^  is  the  atrophy 
of  the  bones  and  soft  parts  of  the  foot  ;  the  forcing  upwards 
and  backwards  of  the  tarsus,  the  displacing  of  the  calcaneus, 
whose  axis  approximates  to  that  of  the  tibia." — (Corre.) 

The  Slavonian  women,  of  Russia,  give  their  babies  a  more 
general  stretching  and  rectifying  of  all  organs  :  upon  the 
second  or  third  day  the  nurse  takes  the  little  body  to  the 
oven  or  the  bath  room,  and  switches  it  well,  then  soaps  it, 
whilst  a  wise  woman  presses  the  head  to  rights  by  working  it 
from  all  sides,  cleanses  the  skin  with  salt  water,  puts  the  nose 
in  good  shape,  stretches  hands  and  feet,  seizing  the  little 
victim  by  the  left  hand  and  right  foot  and  vice  versa,'  finally 
he  is  seized  by  both  feet,  suspended  head  down,  and  well 
shaken  so  as  to  get  the  intestines  in  place,  and  take  internal  ^ 
ruptures  away  from  the  kidneys. 

Few  peoples  are  so  general  in  their  efforts,  as  almost  all 

have  some  peculiar  organ  which   they   seek  to   develop   in 

accordance  with  their  particular  aesthetic  craze.     Most  Afri- 

!  can  tribes  alFect  long  pendulous  breasts  ;  some  constrict  the 

mamraaj  just  below  the  areola,  so  as  to  give  the  appearance 

iFuzier.  D<;formation  du  pied  chez  les  Femmes  Chinoises,  M4m.  de 
M6d.  et  de  Chir.  Mil.  3«s.  VIII,  1862. 


FBEGNANCY,  PATURITION  AND  CHILDBED.  45 

of  a  small  liemispliere  superimposed  upon  a  larger  one. 
Some  like  a  long  pendulous  lower  lip,  and  others  a  thick 
upper  lip  ;  whilst  the  natives  of  Madagascar  affect  excessively 
long  nymphte. 

These  types  of  beauty  are  attained  by  tedious,  long-con- 
tinued efforts,  whilst  others  are  produced  more  rapidly  ;  such 
as  opening  in  nose  and  ears  and  lips  fur  ornaments,  tattooing, 
and  various  marks  and  incisions  upon  the  body  common 
among  different  tribes  and  jDeoples. 

Other  mutilations  to  which  the  infant  is  subjected  are  dic- 
tated by  religious  superstition  ;  yet  the  original  cause  is 
often  Ions:  forgotten,  and  custom  alone  remains  to  account 
for  the  practice.  Among  the  most  ancient  of  these  is  cir- 
cumcision, which  has  been  in  use  by  the  laws  of  Judaism 
and  Islamism  ;  but  it  is  a  biblical  error  to  suppose  that  it 
existed  among  all  people.  Certain  traces  of  this  operation 
have  indeed  been  observed  among  the  Mexicans-  -a  simple 
incision  upon  one  side  of  the  fraenum.  The  incision  of  the 
prepuce  is  practiced  among  the  Milanesians,  New  Caledonians 
and  the  Polynesians.  Partly  inaugurated  for  hygienic  pur- 
poses, and  perhaps  desirable  on  account  of  the  considerable 
develojDment  of  the  prepuce  of  the  Semitic  races,  circum- 
cision, which  was  considered  a  sjnnbol  of  the  alliance  with 
the  Almighty,  has  finally  degenerated  among  the  Jewish 
people  into  a  routine  practice  not  always  exempt  from  dan- 
ger— infection  may  follow,  hemorrhages  and  malformation. 
I  have  myself  seen  an  infection  of  this  kind,  accompanied 
by  well  marked  shankers,  and  followed  by  serious  constitu- 
tional disturbances. 

Among  Mussulman  people  circumcision  is  obligatory,  al- 
though the  Koran  says  nothing  of  it.  The  Arabs  ot  Algiers 
practice  it  towards  the  fifth  year ;  the  Kabyles  towards  the  sixth 
or  eighth  year  ;  the  Turks  towards  the  eighth.  In  Africa  it 
exists  here  and  there,  but  is  not  universal.  In  Rio  N^unez 
circumcision  has  been  practiced  at  twenty-five  and  thirty 
years,  and  an  old  inhabitant  gives  a  curious  explanation  of 
the  reason  for  the  operation,  which  is  that  the  gland, 
always  uncovered  and  exposed  to  continual  irritation,  loses 


46  LABOR:   AN  ETHNOLOGICAL  STUDY. 

its  sensibility,  wliicli  necessitates  a  lengthening  of  the  act  of 
copulation  and  the  enjoyment  of  the  pleasure.  This  is  a 
peculiar  view,  in  ojDposition  to  the  belief  of  those  who  advise 
the  operation  for  the  sake  of  morality — in  opposition  to  St. 
Jerome,  who  teaches  that  the  removal  of  the  pre23uce,  in 
diminishing  the  voluptuous  sensation,  preserves  man  from  too 
great  an  abandonment  to  sexual  pleasures — in  opposition  to 
Moses,  who  by  this  operation  endeavors  to  prevent  the  re- 
sults of  too  ardent  an  imagination. 

Circumcision,  if  we  may  so  call  it,  among  girls  consists  in 
several  operations  : 

First,  a  simple  excision  of  the  clitoris,  at  the  eighth  or 
ninth  year,  upon  the  coast  of  Guinea  ;  at  the  first  appearance 
of  the  courses  in  old  Calabar. 

The  child  is  placed  upon  the  knees  of  a  woman,  the  legs 
are  well  separated,  the  labia  separated,  and  the  slightly 
developed  clitoris  seized  between  two  pieces  of  bamboo  used 
like  forceps,  drawn  forward  and  cut  off  with  a  razor  ;  hem- 
orrhage is  slight,  and,  if  necessary,  is  stopped  by  the  alternate 
use  of  hot  and  cold  water. 

Second,  excision  of  the  nymphie,  only  practiced  on  account 
of  hypertrophy  or  degeneration,  to  which  the  negress  is 
subject. 

Third,  excision  of  the  nymphse  and  the  clitoris  upon  the 
adult;  and,  influenced  by  the  belief  that  it  is  a  guarantee  of 
chastity,  done  upon  such  women  as  are  proud  of  or  anxious 
for  a  proof  of  their  virtue. 

Fourth,  the  excision  of  the  large  lips,  alone  or  with  the 
preceding  oj^erations. 

The  Hottentots  remove  a  testicle  from  boys  at  the  ninth  or 
tenth  year,  with  the  idea  of  preventing  the  conception  of 
twins.  The  Mika  operation  among  Australians  is  peculiar, 
performed  for  the  purpose  of  limiting  the  number  of  pro- 
ductive males.  This  consists  in  an  incision  in  the  lower  part 
of  the  urethra,  near  the  scrotum,  so  that  the  spermatozoa  are 
ejected  through  this  opening,  outside  the  vagina,  and  not 
within  the  canal. — (Corre.) 

Ethnological  differences  in  regard  to  the  growth  and  de- 


PREGNANCY,  PABTUBITION  AND  CHILDBED.  47 

velopment  of  tlie  child  I  have  not  been  able  to  determine, 
with  the  material  at  my  disposal,  notwithstanding  the  variety 
of  statements  made.  I  can  hardly  venture  an  assertion  more 
definite  than  this,  that  the  new-born  among  primitive  peo- 
ples seem,  if  anything,  more  inclined  to  preser\'e  and  develop 
hereditary  taints  and  diseases  by  reason  of  the  long  period 
of  nursing,  which,  as  I  have  previously  stated,  varies  from 
two  to  three  and  even  five  years,  and  is  evidently  a  matter 
which  has  attracted  the  attention  of  ancient  lawgivers,  by 
reason  of  its  marked  eft'ect  upon  the  development  of  the  race. 
Upon  the  Slave-Coast  the  nursing  mother  is  sent  for  three 
years  away  from  her  husband  into  the  interior,  to  avoid  co- 
habitation and  properly  raise  her  child.  Should  she  approach 
a  male,  it  is  supposed  that  the  evil  spirit  will  carry  away  the 
milk  and  kill  the  babe.  In  Rio-Nunez  the  banished  wife, 
knowing  the  path  her  faithful  spouse  will  take,  selects  herself 
a  substitute  to  fill  her  place  in  the  heart  of  her  loving  lord 
during  the  period  of  nursing. 

The  Arabs  are  not  so  careful  as  to  avoid  cohabitation  com- 
pletely while  nursing,  nor  has  the  Prophet  expressly  forbid- 
den it,  although  he  intimates  that  sexual  congress  is  not 
compatible  with  healthy  nursing.  Their  law  renders  the 
suckling  of  the  babe  obligatory  for  the  mother,  except  in 
case  of  sickness,  or  absence  of  milk,  even  after  repudiation 
by  her  husband;  it  is  so  unjust  as  to  oblige  her  to  keep  a  wet 
nurse  in  case  of  her  own  inability  to  nurse,  without  allowing 
her  any  claims  upon  the  father  of  the  child. 

The  dread  of  an  increase  in  the  family,  misery,  poverty,  and 
the  difficulty  of  obtaining  food,  explains  the  long  period  of 
nursing  among  all  these  peoples;  the  child  is  suckled  for 
years  beyond  the  time  indicated  by  nature,  in  the  hope  of 
thereby  preventing  a  farther  conception,  or  because  food  for 
one  more  mouth  cannot  be  provided.  The  child  is  scantily 
fed  upon  an  inferior  milk,  draining  away  the  mother's 
strength  and  energy,  whilst  a  little  properly  prepared  food, 
animal  or  vegetable,  would  rapidly  build  up  the  skinny 
little  one  and  save  the  mother. 

It  is  this  long  continued  assimilation  of  a  tainted  mother's 


48  LABOB:  AN  ETHNOLOGICAL   8TUDY. 

milk  wliich  enfeebles  tlie  nursling,  and  makes  him  an  easy 
victim  to  any  one  of  the  numerous  diseases  which  endanger 
the  earlier  years  of  life. 

In  Chayenne  white  women  often  take  black  nurses,  and  it 
is  well  known  that  the  children  nursed  by  them  frequently 
become  thin,  feeble  and  languishing,  and  above  all  are  much 
more  subject  to  disease;  this  is  undoubtedly  due  to  the  fact 
that  the  negress  of  Chayenne  so  frequently  carries  the  germs 
of  one  or  more  of  the  constitutional  diseases  to  which  the 
blacks  are  subject.  If  the  child  of  a  healthy  mother  is  so 
aifected  by  this  necessity  of  life,  how  much  more  fatal  a  car- 
rier of  disease  must  it  be  for  the  nurse's  own  child! 

Mortality  among  the  negroes  is  great;  many  die  upon  the 
first  day  from  hemorrhage  from  the  navel,  or  from  exposure 
to  cold.^  In  Darien,  families  are  often  scarcely  able  to  raise 
one  child  out  of  twelve:  in  China  and  Japan  the  death  rate 
is  terrible.  Kachitis  is  not  known  in  the  warmer  climates: 
scrofula  seems  to  exist  among  the  Africans,  and  more  so 
among  the  blacks  of  the  Antilles;  in  China  and  Japan  it  is 
very  common;  among  the  Malay  and  Indo-Chinese  races 
scrofula  is  common,  also  in  the  Algerian  and  Moorish  vil- 
lages; the  Arabs  treat  the  disease  by  encircling  the  neck 
with  brier  leaves,  or  a  mixture  of  grenate  bark  and  clean 
barley.  At  Tonga  terrible  lacerations  upon  the  neck,  also 
seen  upon  the  Oceanic  Islands,  syphilis,  lepra  and  small-pox 
are  common  among  the  peoj)le. 

The  Arabs  pay  more  attention  than  most  others  to  their 
children,  but  how  do  they  endeavor  to  strengthen  them? 
By  all  sorts  of  odd  brewings,  such  for  instance  as  (the  only 
nourishment  in  three  or  six  days)  an  egg  cooked  an  entire 
night  in  vinegar,  and  so  on.  In  Spetza  and  Hydra  a  pecu- 
liarly painful,  feverish  disease,  named  ponos  (pain),  which 
has  for  its  basis  consumptive  tendencies,  appears  towards 
the  end  of  the  first  year,  rarely  towards  the  third  or  fourth, 

^I  have  culled  from  Corre's  excellent  work  these  carefully  collected 
statements,  which  afford  an  insight  into  the  diseases  to  which  the  new- 
born is  subject  among  different  races. 


PREGNANCY,  PABTUBITION  AND  CHILDBED.  49 

more  common  among  boys  tliun  girls,  seizing  more  particu- 
larly upon  the  children  of  consumptive  parents  with  lym- 
phatic, weak  constitutions.  Typhoid  fever,  yellow  fever, 
cholera,  malaria,  all    exist. 

Among  all  races  the  young  seem  particularly  given  to  the 
eruptive  fevers.  Variola — which  is  particularly  bad  for  chil- 
dren, removes  a  terrible  number  among  the  North  Amer- 
ican Indians,  Arabs,  Persians,  Chinese  and  Japanese  ;  many 
even  fight  against  it  by  inoculation  with  matter  from  already 
affected  subjects,  as  has  often  been  seen  by  Dr.  Corre  upon 
the  eastern  coast  of  Africa.  In  Arabia  the  virus,  which  is  an 
object  of  public  sale,  is  inoculated  by  an  ordinary  needle;  and 
in  all  nations  it  seems  to  have  been  observed  that  inoculated 
variola  is  always  less  severe  than  the  spontaneous  variety.  The 
Arabs  see  an  especial  advantage  in  the  fact  that  it  is  accom- 
panied by  a  much  smaller  number  of  pustules.  In  India 
the  English  have  again  brought  among  the  natives  the 
ancient  practice  of  inoculation,  known  to  the  ancient  in- 
habitants and  described  in  a  Sanscrit  book.  The  Chinese 
have  accepted  vaccination;  and  also  the  Japanese.  In  Boke 
the  French  surgeons  have  not  been  able  to  establish 
vaccination,  having  attempted  it  with  tubes  imported  from 
France,  as  the  natives  compared  these  negative  results  with 
the  beautiful  pustules  which  resulted  from  their  own  inocu- 
lation of  variola  matter,  not  considering  that  the  eftect  was 
as  good  with  much  slighter  annoyance.  The  Arabs  did  not 
take  kindly  to  vaccination,  believing  that  it  was  merely  a 
means  of  marking  their  children  with  the  insignia  of  their 
conquerors,  declaring  that  they  would  rather  cast  their 
babes  into  the  sea  than  allow  the  sign  to  be  impressed 
on  them,  so  that  they  iniglit  be  known  at  any  time,  to  be 
taken  away  from  their  family  for  baptism. 

An  ethnological  influence  upon  the  appearance  of  the  pus- 
tule, and  its  shape,  form  and  size,  seems  hardly  possible; 
excepting  the  difference  in  thickness  of  the  skins  of  various 
races;  the  pustules  develop  in  the  same  manner  when  they  are 
under  the  same  climatic  influences,  still  some  believe  that  they 
are  smaller  among  the  blacks  than  the  whites.    Climatic  influ- 


50  LABOB :  AN  ETHNOLOGICAL  STUDY. 

ences  are  greater  and  the  pustules  are  smaller  in  hot  climates 
than  in  temperate  or  cold.  In  Cochin  China  the  pustule  pre- 
sents upon  the  fifth  day  the  appearance  it  has  with  us  upon 
the  eighth,  and  gives  an  excellent  lymph  upon  that  day.  In 
India,  and  especially  in  Indo-China,  it  has  been  remarked 
that  at  certain  periods  of  excessive  dryness,  or  excessive 
humidity,  the  vaccination  would  not  succeed.  Strange  to 
say,  the  author  has  vaccinated  unsuccessfully  a  large  num- 
ber of  children  in  one  village,  and  upon  the  following  day 
with  good  success  children  of  the  same  age  and  kind  with 
the  same  matter  in  another.  Could  it  be  possible  that 
these  children  could  have  acquired  an  immunity  from 
the  fact  that  an  epidemic  of  variola  had  existed  in  the 
village  upon   the  preceding  year? 

Scarlatina  is  common  among  other  races.  Grippe  is  rare 
in  hot  climates.  Diphtheritis,  however,  is  frequent  there; 
in  Algeria  it  is  very  common.  Umbilical  hernia  is  common 
among  the  new-born  of  the  black  races;  if  it  does  not  exist 
at  the  moment  of  birth  it  appears  soon  afterwards  :  possibly 
a  persistence  of  the  embryonic  state.  Convulsions  and  eclamj)- 
sia  are  very  common.  Vertigo,  congenital  and  accidental,  is 
very  common  among  all  colored  races.  The  same  is  true  of 
cicatricia  and  hypertrophy 


CHAPTEE  II. 


POSTURE  IN  LABOR. 


INTRODUCTION. 

As  it  was  this  feature  to  which  my  attention  was  first  at_ 
tracted,  I  will  ask  the  indulgence  of  the  reader  for  a  few  brief 
introductory  remarks,  explanatory  of  the  manner  in  which 
this  entire  subject,  novel  at  the  time,  but  now  rapidly  gaining 
in  interest  and  popularity,  was  developed. 

It  was  my  good  fortune  in  1877  to  add  a  valuable  collec- 
tion of  ancient  Peruvian  pottery  to  my  archeological  mu- 
seum. At  the  same  time,  whilst  interested  in  these  matters, 
I  was  told  of  an  urn  or  vessel  brought  from  the  ancient 
graves  of  Peru,  which  represented  a  midwife  delivering  a 
woman  in  labor,  and  was  then  stowed  away  in  the  home  of 
its  discoverer,  Dr.  Coates,  of  Chester,  Penn.  My  interest 
was  at  once  aroused  and  I  wrote  to  the  gentleman  request- 
ing a  photograph  or  cast  of  this  unique  piece  of  pottery. 
I  received  no  answer,  but  constantly  bore  the  subject  in 
mind,  until,  finally,  upon  my  visit  East  in  1879,  ^Y  esteemed 
friend,  Dr.  Albert  H.  Smith,  of  Philadelphia,  enabled  me, 
through  the  kind  offices  of  Dr.  Anna  E.  Broomall,  to  exam- 
.ne  the  specimen,  which  proved  so  intensely  interesting  to 
me  that  I  determined  to  satisfy  myself  as  to  the  correctness 
and  the  historic  value  of  this  group,  and,  moreover,  to  study 
the  subject  of  posture  in  labor.  This  ancient  Peruvian 
funeral  urn,  well  characterized  in  the  heliotype  which  ac- 
companies this  article,  is  one  of  the  oldest  distinct  and  well 
authenticated  representations  of  a  labor  case  which  is  extant. 
The  method  of  delivery  followed  by  those,  at  that  time,  high- 
ly civilized  people,  a  thousand  or  more  years  ago,  seemed  to 
me  so  peculiar  that  I  was  anxious  to  know  whether  other 
people  had  similar  curious  customs  and  whether  any  traces 
of  these  could  be  found  at  the  present  day;  moreover,  it  ap- 
peared to  me  as  if  a  study  of  obstetric  customs  among  the 
more  primitive  people  might  lead  to  valuable  results  which 


52  LABOR:   AN  ETHNOLOGICAL  STUDY. 

would  serve  to  guide  the  practice  ot  the  present  day.  My 
interest  was  thoroughly  aroused,  and  by  the  kind  offices  of 
the  gentlemen  in  charge  of  the  Library  in  the  Surgeon- 
general's  office  its  fund  of  well-arranged  material  was  kindly 
placed  at  my  disposal,  so  that  I  was  enabled  at  once  to  en- 
ter upon  the  study  of  the  subject  which  had  so  deeply  en- 
grossed my  attention.  I  found  an  extensive  literature  re- 
lating to  the  subject  of  posture  in  labor,  but  it  turns  entirely 
upon  the  discussion  of  the  relative  merits  of  the  dorsal  de- 
cubitus, as  practised  upon  the  continent  of  Europe  and  in 
America,  and  the  left  lateral  position,  which  is  favored  in 
England  ;  perhaps,  also,  the  knee-elbow  position  may  come 
into  question,  but  the  discussions  are  entirely  confined  to 
the  merits  of  those  positions  which  are  taught  by  modern 
obstetric  law,  and  enforced  in  all  civilized  communities  of 
the  present  day  where  scientific  'medicine  rules.  Some  had 
gone  beyond  this  and  had  attempted  to  determine  the  natural 
position  of  woman  in  labor  by  the  study  of  the  position  which 
had  been  occupied  by  unfortunate  girls,  in  concealed  or  se- 
cret parturition  ;  thus  Schutz,^  and  Dr.  Cohen  v.  Baeren  in 
Posen,  who  cites  one  hundred  such  cases  ;  fifty  of  which 
occurred  in  unusual  positions  :  thirty  standing,  eighteen 
crouching  or  squatting,  and  two  kneeling.  Of  the  fifty  cases 
recorded  by  Schiitz,  thirty-two  —  over  half  —  occupied  ab- 
normal positions  :  fourteen  standing,  sixteen  crouching  or 
squatting,  two  kneeling.  Nasgele,  on  the  contrary,  sought 
to  discover  the  natural  position  in  labor  by  secretly  observ- 
ing the  movements  of  an  inexperienced  girl  who  was  left 
alone,  while  in  pains,  in  a  room  furnished  vv^ith  a  bed,  chair, 
sofa,  and  an  obstetric  chair.  The  girl  took  all  possible  posi- 
tions and  was  finally  delivered  tossing  about  on  the  bed  ; 
she  had  sought  the  obstetric  chair  but  gave  it  up  after  a 
moment's  trial  which  appeared  so  conclusive  to  her  mind 
that  she  did  not  repeat  the  attempt.  Hohl  ^  in  his  clinic 
made  an  attempt  to  see  whether  women  could  be  confined 
standing,  and,  though  a  great  many  had  been  urged  to  try, 

1  Verhandl.  d.  Gesellsch.f.  Gebiirtsh.  in  Berl.,  iv.,  page  37. 
^  Lehrb.  d.  Geburtsh.,  2  Aufl.,  Leipaig,  I862,  page  114. 


POSTURE.  53 

only  one,  induced  by  a  considerable  bribe,  had  been  able  to 
complete  her  labor  in  this  position  ;  hence,  he  concluded 
that  all  accounts  of  women  being  thus  confined  must  be  false 
—  an  erroneous  conclusion,  as  I  shall  hereafter  show.  The 
first  who  departed  from  the  beaten  track  and  entered  upon 
the  proper  course  to  determine  the  natural  position  of 
women  in  labor,  namely,  by  historical  and  ethnological  re- 
searches, was  Rigby,  in  his  paper,  published  in  the  "  Med- 
ical Times  and  Gazette,"  for  1857,^  "What  is  the  natural 
Position  of  Women  During  Labor  ?  "  He  refers  to  the  meth- 
ods previously  followed,  then  traces  those  peculiar  positions 
which  are  still  customary  in  secluded  parts  of  England,  Scot- 
land, Wales,  and  Ireland,  and  seems  to  come  to  the  conclu- 
sion that  accidental  circumstances  determine  in  a  great 
measure  the  position  which  the  unassisted  woman  assumes 
when  seized  with  violent  pains  effecting  the  expulsion  of  the 
child  ;  that  she  probably  walks  or  tosses  about,  finally  to  be 
delivered  in  a  recumbent  position  ;  and  rather  seems  to  in- 
dorse the  views  of  his  West  India  correspondent,  "  That 
there  is  no  natural  position,  in  labor,  for  the  native  women, 
any  more  than  for  a  man  with  colic  or  a  West  India  dry 
belly." 

The  next  and  most  complete  work  on  the  subject  was  by 
Dr.  H.  H.  Ploss,^  "  Ueber  die  Lage  und  Stellung  der  Frau 
vvaehrend  der  Geburt  bei  verschiedenen  Volkern."  He,  with- 
out entering  upon  a  theoretical  discussion  of  the  question, 
gives  us  the  results  of  his  very  thorough  study  of  the  posi- 
tions occupied  by  women  in  labor  among  the  ancients  and 
among  the  uncultured  and  savage  races  of  the  present  day. 
He  recognizes  the  positions  assumed  as  :  Firstly,  recumbent 
in  a  more  or  less  horizontal  position.  Secondly,  sitting  : 
{a)  in  bed  ;  {b}j  on  a  stool  ;  {c)  on  a  chair  ;  {d)  on  a  cush- 
ion ;  (^.)  on  the  thighs  of  another  individual.  TJdrdlyy 
standing.  Fourthly,  kneeling.  FiftJily,  squatting.  Sixthly, 
swinging.  SeventJily,  suspended  in  an  erect  posture.  I  shall 
not  infrequently  refer  to  the    authorities   quoted     by  Dr. 

'  Vol.  XV.,  page  345. 
2  Leipzig,  1872. 


54  LABOR:   AN  ETHNOLOGICAL  STUDY. 

Ploss,  although  in  some  cases  the  details  of  reports,  which 
I  have  obtained,  vary  decidedly  from  the  often  very  meagre 
statements  made  by  him  ;  and  in  other  cases  he  has  based 
his  assertions  upon  very  questionable  and  indefinite  ac- 
counts of  travelers,  which  he  has  evidently  made  use  of  in 
order  to  make  his  paper  as  complete  as  possible.  In  the 
main  it  is  a  sound  paper  showing  a  great  deal  of  pro- 
found research  among  the  best  of  authorities,  ancient  and 
modern.  I  cannot,  however,  agree  with  his  conclusion, 
namely,  "that  among  the  majority  of  people  the  parturient 
women  assume  the  recumbent  position."  He  seems  to 
think  that,  though  not  necessarily  in  an  entirely  horizontal 
position,  she  is  delivered  lying  upon  a  bed  or  a  couch  of 
some  kind. 

I  might  add  that  in  1870,  a  paper  appeared  in  Breslau, 
by  H.  v.  Ludwig,^  in  which  the  author,  upon  theoretical 
grounds,  advocates  the  kneeling  or  squatting  positions  to 
be  assumed  during  the  expulsion  of  the  child,  and  insists 
that  the  women  of  savage  races,  of  people  who  still  exist 
under  the  most  natural  conditions,  instinctively  assume 
these  positions.  As  soon  as  my  attention  had  been  once 
directed  to  this  subject  by  that  remarkable  funeral  urn,  rep- 
resenting the  custom  of  the  ancient  Peruvians,  and  I  had 
entered  upon  the  study  of  the  posture  occupied  during  la- 
bor by  the  women  of  other  people,  I  found  a  great  variety 
in  their  customs  ;  but  it  soon  became  evident,  and  impressed 
tself  forcibly  upon  my  mind,  that  the  recumbent  position 
in  labor  is  rarely  assumed  among  those  people  who  live 
naturally  and  are,  as  yet,  governed  by  their  instincts  and 
have  escaped  the  influence  of  civilization  and  of  modern 
obstetrics.  It  certainly  appeared  as  if  the  ordinary  obstet- 
ric position  of  to-day  must  be  an  unnatural  one,  and  in  or- 
der to  study  the  question  as  to  what  is  the  natural  position 
of  women  in  labor,  the  proper  and  only  course  to  be  fol- 
lowed seemed  to  me  to  investigate  :  — 

I.  The  position  occupied  by  women  in  labor  among  the 

1  "  Warum  lasst  man  die  Frauen  in  der  Riickenlage  gebaeren  "i  " 


POSTURE.  55 

nations  of  the  past ;  especially  among  those  who  boasted  of 
higher  civilization. 

2.  To  observe  the  position  assumed  by  women  in  labor 
among  savage  races  of  the  present  day  whose  movements 
are  still  governed  by  instinct. 

I  deem  it  a  great  mistake  that  we  in  this  age  of  culture, 
should  follow  custom  or  fashion  so  completely,  to  the  ex- 
clusion of  reason  and  instinct,  in  a  mechanical  act  which 
so  nearly  concerns  our  animal  nature  as  the  delivery  of  the 
pregnant  female.  If  we  wish  to  obtain  an  idea  of  the  nat- 
ural position  we  must  look  to  the  woman  who  is  governed 
by  instinct,  not  by  prudery  ;  and  it  is  only  among  the  savage 
races  that  we  shall  find  her  at  the  present  day.  In  this 
purely  animal  function  instinct  will  guide  the  woman  more 
correctly  than  the  varying  customs  of  the  times. 

3.  In  our  obstetric  practice  of  to-day  to  observe  the 
movements  of  women  and  the  positions  which  they  invol- 
untarily assume  in  the  agony  of  the  expulsive  pains  when 
instinct  comes  forward,  to  the  exclusion  of  every  other  feel- 
ing.    I  have  accordingly  — 

1.  Sought  such  information  as  history  could  give  me  — 
as  could  be  afforded  by  our  larger  libraries,  especially  that 
of  the  Surgeon-general's  office  in  Washington  ;  and  I  have 
made  free  use  of  the  references  given  by  PIoss  in  his  work 
already  referred  to,  and  by  Goodell,^  in  his  instructive  paper 
on  "  Some  Ancient  Methods  of  Delivery." 

2.  In  order  to  obtain  information  as  to  the  position^  as- 
sumed by  those  people  among  whom  no  modern  obstetric 
law  or  custom  as  yet  prevails  —  among  the  savages  of  the 
present  day  —  I  have  corresponded  with  leading  obstetri- 
cians in  foreign  countries,  as  well  as  travelers  who  were 
likely  to  assist  me  in  this  inquiry.  I  have  sought  informa- 
tion from  physicians  in  various  portions  of  our  own  coun- 
try, partly  by  correspondence,  partly  by  questions  kindly  put 
to  their  readers,  by  a  number  of  our  medical  journals.  The 
most  valuable  information,  however,  I  have  obtained  through 
circulars  sent  to  the  medical  ofificers  of  the  army  and  the 

1  Am.  J.  ObsL,  February,  1872. 


56  LABOR:   AN  ETHNOLOGICAL  STUDY. 

physicians  to  the  Indian  Agencies,  through  the  Bureau  of 
Ethnology  of  the  Smithsonian  Institution  in  Washington. 

3.  I  have  made  it  my  duty  to  observe  the  positions  as- 
sumed by  women  at  the  very  moment  of  the  expulsion,  dur- 
ing the  agony  of  the  last  pains. 

The  subject  will  be  divided  as  follows  :  — 

The  Introduction. 

Part  I.,  treating  of  the  position  of  women  among  peo- 
ple whose  labor  is  governed  by  instinct  and  not  by  prudery 
or  the  laws  of  obstetrics. 

Part  II.  The  position  of  women  among  civilized  races 
of  the  present  day,  in  the  agony  of  the  expulsive  pains. 

Conclusions  ;  and  these,  I  will  briefly  state,  are  :  that  the 
semi-recumbent  and  inclined  positions  are  the  correct  ones 
for  the  parturient  woman,  —  anatomically,  theoretically,  and 
practically,  —  and  that  we  have  unquestionable  ethnological 
proof  of  this  assertion.  We  must  resume  the  semi-recum- 
bent position,  and  it  becomes  a  question  whether  we  should 
return  to  the  obstetric  chair  or  not. 

I  have  classified  the  positions,  according  to  the  inclina- 
tion of  the  axis  of  the  body,  into  :  The  perpendicular  or  up- 
right, the  inclined,  and  the  horizontal  or  recumbent. 

A.  Perpendicular :  — 

1.  Standing. 

2.  Partially  suspended. 

3.  Suspended. 

B.  Inclined  :  — 

1.  Sitting  erect  on  stool,  cushion,  or  stone. 

2.  Squatting,  as  in  defecation. 

3.  Kneeling. 

{a)  With  the  body  inclined  forward,  and  resting  on  a 
chair  or  staff. 

(^.)  Knee-elbow  position,  knee-breast,  or  knees  and  hands. 
(r.)  With  the  body  erect  or  inclined  backwards. 
{d)  Not  definitely  described. 

4.  Semi-recumbent. 

(rt.)  Sitting  semi-recumbent  on  the  ground,  a  stone,  or 
stool. 


POSTURE.  57 

{b.)  On  the  lap  or  between  the  thighs  of  an  assistant  who 
is  seated  on  a  chair  or  on  the  floor. 
{c.)  The  obstetric  chair. 

{d.)  Semi-recumbent  positions,  strictly  speaking. 
C.  Horizontal  or  recumbent. 
(^.)  On  the  back. 
(^.)  On  the  side. 
(c.)  On  the  chest  and  stomach. 

I  have  been  aided  in  this  work  by  so  many  kind  friends 
and  fellow  practitioners  that  I  feel  it  my  duty  to  express 
my  thanks  to,  at  least,  some  of  them,  for  the  valuable  assist- 
ance rendered.  Dr.  Isaac  Coates,  formerly  of  Chester,  Penn., 
gave  the  impulse  to  this  undertaking  by  kindly  permitting 
me  to  photograph  the  historic  urn  which  he  unearthed  from 
its  resting  place,  that  it  might  reveal  to  us  the  life  of  a  peo- 
ple long  since  passed  away ;  and  it  is  owing  to  the  efforts 
of  Dr.  Anna  E.  Broomall  that  I  was  actually  enabled  to  do 
this.  The  kindness  of  Drs.  Billings  and  Fletcher  readily 
enabled  me  to  obtain  much  important  information  from  the 
vast  and  well  catalogued  materials  of  the  Surgeon-general's 
library.  To  Dr.  H.  C.  Yarrow  my  especial  thanks  are  due 
for  his  unceasing  efforts  in  the  interest  of  this  undertaking ; 
his  position  and  his  researches  in  the  library  of  the  Sur- 
geon-general's office  enabled  him  to  extend  to  me  many  fa- 
vors ;  with  the  consent  and  at  the  direction  of  Major  J.  W. 
Powell,  in  charge  of  the  Bureau  of  Ethnology  of  the  Smith- 
sonian Institution,  aided  by  other  friends,  he  has  sent  out 
a  series  of  circulars  to  the  surgeons  of  the  army  and  Indian 
Agencies  requesting  information  as  to  the  obstetric  prac- 
tices among  our  North  American  Indians ;  I  also  gratefully 
acknowledge  my  indebtedness  to  the  medical  officers  of  the 
United  States  army,  and  the  physicians  to  the  Indian  Agen- 
cies, for  the  valuable  information  given,  and  their  cheerful 
and  generous  response  to  the  circular  sent.  Dr.  Raoul 
Fauquez,  of  Paris,  had  the  kindness  to  offer  information 
upon  the  subject  in  the  various  departments  of  France. 
Several  of  our  medical  journals  placed  before  their  readers 


58  LABOR:   AN  ETHNOLOGICAL  STUDY. 

my  questions  as  to  the  obstetric  practices  in  remote  regions 
of  this  country,  and  numerous  professional  friends  through- 
out the  entire  land  have  given  me  valuable  information  as 
to  the  country  practice  in  earlier  days.  Mr.  Ad.  Bandelier, 
that  ardent  archeologist  from  our  neighbor  State,  gave  me 
an  insight  into  the  customs  of  the  natives  at  the  time  of 
the  conquest  by  reference  to  his  valuable  library  of  ancient 
Spanish  authorities.  To  my  friend  Dr.  C.  W.  Cooper  I 
owe  thanks  for  valuable  assistance  rendered  throughout  the 
entire  work. 

Quite  a  number  of  the  instructive  illustrations  I  owe  to 
the  genius  of  St.  Louis'  talented  artist,  Mr.  Carl  Gutherz ; 
whilst  Dr.  H.  H.  Ploss,  of  Leipzig,  has  permitted  the  use  of 
several  of  the  cuts  from  his  own  work. 

GEOGRAPHICAL    DISTRIBUTION. 

Europe. 

The  dorsal  decubitus,  with  the  woman  recumbent  in  bed,  is  now  al- 
most universal,  having  superseded  the  obstetric  chair  of  the  beginning 
of  this  century.  Peculiar  positions  are  still  found  here  and  there  in  re- 
mote districts. 

France.     A  standing  position  is  occasionally  assumed. 
Italy.     Semi-recumbent  on  the  lap  ;  and  in  earlier  days  knee-elbow, 
semi-recumbent  in  bed,  and  erect,  clinging  to  the  neck  of  an  as- 
sistant. 
Spain.     Kneeling. 
Cermatiy.     Standing;   on  the  lap  of  an  assistant;  partly  suspended; 

semi-recumbent  in  bed,  or  in  a  shng. 
Russia.     Erect,  wholly  suspended  ;  squatting  ;  k'leehng  ;  sitting  erect 

and  in  the  lap  of  an  assistant. 
Sweden.     Recumbent. 

Greece.     Kneeling  and  semi-recumbent  in  bed,  or  on  a  low  stool  reclin- 
ing against  an  assistant,  in  ancient  Greece.    In  later  times,  recum- 
bent in  bed,  or  semi-recumbent  on  a  low  stool,  reclining  against  an 
assistant,  which  appears  still  very  common. 
Turkey.     Chair  ;  sitting  on  a  stool. 

Great  Britain.  Clinging  to  the  neck  of  an  assistant ;  kneeling,  arms 
resting  on  a  chair  or  in  the  lap  of  an  assistant ;  knee-elbow  posi- 
tion ;  sitting  on  a  low  stool  ;  squatting  ;  sitting  semi-recumbent  in 
the  lap  of  an  assistant  (several  of  these  positions  have  been  fre» 
quently  observed  in  Irish  or  Welsh^emigrants  in  this  country). 


POSTURE.  59 

Asia, 

Kamtschatka.     Kneeling. 

Mongolia.     Kneeling. 

Chifia.     Chair  or  bed. 

Japan.     Chair,  semi-recumbent,  or  kneeling  erect  on  the  floor. 

PJiilippine  Islands.     Standing. 

Smnatra.     Recumbent. 

Sia?n.     Recumbent  ;  lying  on  the  side  or  back. 

Bunnah.     Recumbent,  on  the  back. 

India.  Standing ;  on  the  lap  ;  sitting  on  a  cushion  or  stool  ;  recum- 
bent in  bed. 

Andamati  Islands.     In  the  lap  of  the  husband. 

Persia.     Squatting  or  kneeling. 

Arabia.  Squatting  ;  semi-recumbent  on  the  chair  or  the  lap ;  or  on 
two  flat  stones  clinging  to  a  rope. 

Palestine.     Chair. 

Syria.     Rocking-chair  ;  semi-recumbent. 

Hebrews.     Semi-recumbent  (on  stones  or  a  stool)  and  squatting. 

Cyprus.     Semi-recumbent  on  a  stool  (ancient  and  modern). 

Africa. 
Egypt,  ancient.     Squatting. 
Egypt,  modern.     Chair. 
Abyssinia.     Kneeling  ;  sitting  on  a  stone,  reclining  against  an  assistant 

or  a  tree. 
Ethiopia.     Kneeling;  standing. 
Dar-Fur.     Standing. 

East  Africa.     Standing  ;  sitting  or  squatting. 
Somali.     Standing,  holding  on  to  a  rope. 
Wakamba.     Standing,  bent  over  backwards. 
Kaffraria.     Squatting. 
Hottentots,  Cape  of  Good  Hope.     Standing. 
Old  Calabar.     Sitting  on  a  chair  or  block. 
Wazeg7(a.     Squatting. 
Canary  Islands.     Sitting  erect. 

North  America. 

Canada,  French  settlers.  Semi-recumbent  on  the  floor,  back  against 
an  inclined  chair. 

Canada,  Iroquois.     Standing,  clinging  to  the  neck. 

Mexico,  Indians,  half-breeds,  and  lower  class  of  whites.  Kneeling, 
clinging  to  a  rope  or  the  neck  ;  squatting  ;  standing,  and  semi- 
recumbent  on  the  lap  and  in  bed. 

United  States,  Caucasians  descended  front  various  European  races. 
Kneeling;  squatting;  sitting    on  the  husband's  lap;   semi-recum- 


60  LABOR:   AN  ETHNOLOGICAL  STUDY. 

bent  in  bed  or  on  the  floor,  against  an  inclined  chair  ;  standing, 
and  knee-elbow  position. 

United  States^  Negroes.  Kneeling,  head  in  the  lap;  squatting;  sus- 
pended from  the  limb  of  a  tree. 

United  States,  Indians.  Mostly  kneeling,  clinging  to  a  tent-pole,  the 
body  inclined  forward,  or  to  a  rope  or  horizontal  staff,  the  body 
inclined  back ;  often  squatting  ;  occasionally  sitting  semi-recum- 
bent in  the  lap  or  on  the  floor  ;  semi-recumbent,  or  kneeling  erect ; 
more  rarely  recumbent ;  standing  erect,  clinging  to  the  neck  of  an 
assistant ;  tied  to  a  tree,  or  suspended  ;  and  the  knee-chest  posi- 
tion. 

Central  and  South  America. 

Nicaragua.     Kneeling. 

Guatemala.     Squatting. 

Veneztiela.     Semi-recumbent,  seated  in  a  hammock. 

Peru,  attcient  atid  modern.     Semi-recumbent  in  the  husband's  lap. 

Chili.     Semi-recumbent  in  the  lap. 

Brazil.     Recumbent  on  the  ground  or  in  a  hammock. 

Australia  and  Surrounding  Islands. 

Australia.     Sitting  erect ;  recumbent. 

Ceram. .   Standing  erect ;  suspended. 

Polynesia.     Squatting. 

West  Micronesia.     Squatting. 

New  Zealand.     Kneeling. 

Sandwich  Islands.    Semi-recumbent  on  the  lap,  or  lying  on  a  mat. 


PART  I. 

Position  of  Parturient  Women  etmojig  People  whose  Parturi- 
tion i?  goveriied  by  Instinct  and  not  by  Modern  Obstetric 
Fashion.  —  Among  the  Ancietits.  —  Among  the  Savage 
or  Uncivilized  Races  of  the  present  Day,  and  in  Remote 
Districts  of  Civilized  Countries. 

I  HAVE,  as  already  stated,  determined  to  classify  the  va- 
rious positions,  as  nearly  as  possible,  in  accordance  with  the 
position  assumed  by  the  axis  of  the  body,  and  shall  hence 
consider  first :  A.  The  Perpendicular  or  Upright  Positions  ; 
then  B.  The  Inclined  Positions  ;  and  finally  C.  The  Hori- 
zontal or  Recumbent  Positions. 

A.  PERPENDICULAR   OR    UPRIGHT   POSTURE. 

Under  this  heading  I  shall  discuss,  individually,  those 
positions  in  which  the  body  is  erect  or  almost  so,  and,  in 
accordance  with  some  slight  variations,  will  distinguish  : 
I.  TJie  Standing,  2.  The  Partially  Suspended,  3.  The  En- 
tirely Stispended  Positions. 

I.    STANDING. 

We  shall  find  this  apparently  uncomfortable  position  as- 
sumed even  at  the  present  day,  and  in  our  own  country  : 
Thus,  Dr.  H.  F.  Campbell,  01  Georgia,  writes  me  that  he 
has  delivered  a  patient  standing,  clinging  to  the  bed-post, 
who  would  rather  dispense  with  his  services  than  assume 
any  other  position.  Among  our  Indians  it  is  rarely  ob- 
served, although  I  have  been  informed  by  a  correspondent 
that  the  Sioux  women  are  delivered  standing  erect ;  I  think 


62  LABOR:   AN  ETHNOLOGICAL  STUDY. 

that  we  shall  find  a  partially  erect,  partially  standing,  posi- 
tion more  frequent  among  them.  The  natives  of  the  An- 
tilles, if  we  may  accept  so  venerable  an  authority  as  Fray 
Juan  de  Torquemada,  are  confined  standing,  but  also  at 
times  assume  the  kneeling  or  recumbent  postures.  In 
France  it  seems  to  have  been  quite  a  common  position  in 
some  of  the  interior  departments,  as  Godefroy  ^  warns  his 
colleagues  never  to  permit  the  women  to  be  confined  in  a 
standing  posture,  as  hemorrhage,  prolapse  of  the  uterus,  and 
rupture  of  the  perineum  are  more  apt  to  ensue  than  in  any 
otiier.  During  the  past  century  it  seems  to  have  been  the 
most  common  position  among  the  Sclavonians  in  the  moun- 
tainous regions  of  upper  Silesia,  where,  in  1747,  a  physi- 
cian, in  his  book  on  midwifery,  even  advises  such  patients 
as  do  not  wish  to  be  confined  in  bed  to  assume  this  position, 
with  some  strong  person  supporting  them  from  behind  and 
holding  their  arms,  whilst  others  hold  the  separated  legs, 
and  the  midwife  sits  comfortably  in  front.'^ 

The  Hindoos,  especially  upon  the  eastern  coast  of  India 
and  in  the  vicinity  of  Madras,  are  delivered  in  an  erect, 
standing  posture,  supported  by  an  assistant  under  each 
shoulder  —  the  midwife  attending  to  her  duties,  being 
seated  in  front  of  the  patient,^  and  whether  rare  or  not  at 
the  present  day  the  position  is  certainly  traditionary,  as  bas- 
reliefs  still  exist  upon  the  ancient  Indian  monuments  which 
represent  the  act  of  delivery  in  this  very  same  way. 

In  Central  Africa,  and  near  the  Cape,  among  the  Boers, 
the  standing  posture  is  not  uncommon.  Among  the  Ne- 
gritos, upon  the  Philippine  Islands,  the  parturient  woman 
assumes  the  standing  position,  but  apparently  bent  forward 
a  little,  as  she  supports  the  abdomen  against  a  bamboo  cane 
planted  in  the  ground,  thus  apparently  exercising  some  pres- 
sure upon  the  uterus.*     Among  the  Wakambas,  in  Africa, 

^  Revtie  de  therap.  ined.-chir.,  Par.,  1864,  No.  9,  page  227.    Ploss,  p.  3& 
2  Ploss,  Die  Lage  tind  Stellung  der  Frau  wdhrend  der  Gebtirt,  Leip- 
zig, 1872,  p.  38. 
8  J.  A.  Roberton,  opprak.jutschr.^  1847,  v.  6.     H.  B.  French. 
♦  Mallat,  Les  Philippi7ies,  1846.    Ztschr.  f.  Ethn. 


POSTURE. 


63 


the  patient  assumes  the  standing  posture  assisted  by  two 
friends,  but  bends  over  backwards,  and  a  third  is  seated  in 
front  to  receive  the  child.^ 

A  similar  position  is  shown  in  an  old  painting  in  the 
Academy  of  Medicine   in   New  York.      (See  Fig.  5.)     The 


Fig.  4.  —  Labor  Scene  among  the  Wakarabas.     (Western  portion  of  Central  Africa.) 


history  of  this  picture,  which  represents  some  mythical  or 
mythological  scene,  I  cannot  trace,  but  the  artist  has  cer- 
tainly depicted  the  custom  of  his  period  in  the  position 

^  J.  M.  Hildebrandt,  "  Ethnographische  Notizen  iiber  Wakamba  und 
ihre  Nachbaren,"  Ztschr.f.  Ethn.,  Berl.,  1878,  vol.  x,,  page  394. 


64 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


assumed  by  the  parturient.  For  this  reason  it  has  appeared 
to  me  of  sufficient  interest  to  place  it  sidfe  by  side  with  the 
labor  scene  among  the  less  fanciful  Wakambas. 

The  Loangos,  in  Equatorial  Africa,  are  delivered  stand- 
ing, leaning  against  the  wall  of  the  hut,  or  kneeling,  the 
head  resting  upon  the  arms.  The  reason  assigned  for  this 
procedure  is  that  they  expect  to  obtain  the  desired  head 
presentation  by  assuming  these  positions.    In  difficult  labor 


Fjg.  5. —  Mythical  Labor  Scene. 


the  patient  is  placed  upon  her  face  and  chest,  and  finally 
upon  her  back,  and  choked  and  kneaded  until  an  expulsion 
in  some  direction  is  accomplished.^ 


2.    PARTIALLY    SUSPENDED. 

Parturient  women  endeavor  to  assume   this  position  of 
partial  suspension  in  various  ways.     Some  hang  to  the  neck 

*  Ifidiscretes  aus  Loaiigo.    Dr.  Peschuel-Loesche.    Ztschr.f.  Ethn. 
1878,  X.,  p.  29. 


POSTURE. 


65 


of  a  husband  or  friend,  others  swing  themselves  by  a  rope 
from  the  branch  of  a  tree,  while  some  are  tied  up  until  the 
act  is  over,  as  if  undergoing  punishment.  The  squaws  of  the 
Brule  Sioux,  the  largest  branch  of  the  great  Sioux  Nation, 
are  confined  in  the  midst  of  a  crowd  of  indifferently  solici- 
tous relatives  and  friends,  one  or  more  matrons  always  be- 
ing present  as  midwives. 
In  the  first  stage  of  labor, 
that  is,  prior  to  the  expul- 
sion of  the  liqjLor  ainnii, 
the  squaw  sits  or  lies  up- 
on the  ground  groaning 
vociferously  ;  during  the 
expulsion  of  the  fetus,  her 
posture  is  erect  or  nearly 
so,  with  her  arms  about 
the  neck  of  a  stout  male 
supporter,  and  I  am  in- 
formed upon  credible  au- 
thority that  the  young 
bachelor  bucks  are  most 
frequently  chosen  for  this 
service. 

The  women  of  the  Iro- 
quois in  Canada,  are  all 
confined  standing,  gener- 
ally leaning  on  a  friend's  shoulder,  whilst  the  child  is  taken 
by  the  midwife  behind  the  patient.  The  position  is  prob- 
ably the  same  as  described  among  the  Sioux. 

In  Japan  this  position  is  resorted  to  in  the  attempt  to 
correct  malpositions  in  the  earlier  months  of  pregnancy. 
The  Japanese  medical  man  makes  the  patient  stand  up  and 
put  her  arms  around  his  neck  ;  he  then  presses  his  shoulder 
against  her  breast,  and  his  knees  between  hers  in  such 
a  manner  that  she  is  firmly  supported,  and,  while  »in  this 
position  he  manipulates,  performing  lateral  massage  with 
his  hands,  beginning  with  the  seventh  cervical  vertebra 
and  bringing  them   downward  and  forward,  snapping  his 


Fig.  %.  —  Brule  Sioux.     Standing. 


66  LABOR:   AN  ETHNOLOGICAL  STUDY. 

fingers  to  distract  the  attention  of  the  woman.  Finally,  he 
rubs  the  nates  and  hips  with  the  palms  of  the  hands  for 
wards,  beginning  at  the  sacrum,  and  repeating  the  move- 
ment sixty  or  seventy  times.  This  process  is  repeated  every 
morning  after  the  fifth  month.^ 

The  "New  York  Medical  Record"  adds,  that  the  ac- 
coucheurs are,  in  Japan,  as  a  rule,  advanced  in  age.  If  this 
custom  is  found  in  our  own  country  it  certainly  comes  to 
us  from  some  of  the  inland  countries  of  Europe.  Thus, 
Spence,  in  his  "  System  of  Midwifery,"  ^  says  that  the  posi- 
tion which  is  very  frequently  practised  in  the  northern  por- 
tion of  Scotland,  is  that  of  hanging  about  the  neck  of 
a  person  as  tall,  or,  if  possible,  taller  than  herself,  who 
gently  supports  the  patient's  back,  and  with  her  knees 
fixes  the  knees  of  the  woman  in  labor.  In  Italy  it  was  Sa- 
vonarola, who  died  in  Padua  in  1460,  who  taught  that  in- 
difficult  labors  the  parturient  woman  should  either  hang 
to  the  neck  of  a  stout  person  or  assume  the  knee-elbow 
position.^ 

The  practice  in  some  Mexican  families  ^  is  to  keep  the 
woman  in  an  upright  position,  with  the  knees  and  thighs 
slightly  flexed,  the  feet  wide  apart,,  while  she  supports  her- 
self by  two  ropes  suspended  from  above.  He  adds  that  mas- 
sage is  very  freely  resorted  to,  but  no  binder  is  at  any  time 
used. 

We  find  precisely  the  same  position  in  Africa  among  sev- 
eral native  tribes.  Thus,  the  Somali  women  assume  an 
erect  posture,  partially  suspended  by  a  rope  during  the  ex- 
pulsion of  the  child,  which  is  received  by  a  family  attend- 
ant or  midwife.^  So,  also,  we  find  that  the  women  of  Dar 
Fur,  on  the  Nile,  are  delivered  standing,  with  the  legs  sep- 
arated,^ holding  on  to  a  rope. 

^  La  Frajice  viedicale. 

2  Edinburgh,  1784. 

8  Siebold,  vol.  i.,  page  352.     Ploss,  page  44. 

*  Dr.  Joseph  K.  Carson,  post-surgeon  at  Fort  Yuma,  Cal. 
6  J.  M.  Hildebrandt,  Ztschr.f.  Ethn.,  1878,  vol.  x. 

*  "  Dar  Fur  on  Nile,"  Skizze  der  Nil  Lander,  1866,  page  405. 


POSTURE. 


67 


A  somewnat  more  barbarous  custom  is  that  followed  by 
some  of  our  North  American  Indians,  and  by  the  inhabi- 
tants of  Ceram,  an  island  north  of  Australia,  namely  :  they 
tie  the  patient  to  a  post  or  tree,  with  the  hands  above  the 
head.  The  Coyoteros  are  in  the  habit  of  tying  their 
women,  in  labor,  to  a  tree,  with  the  hands  above  the  head, 


Fig    7-     Ceram.     Stancliiig,  semi-suspended. 


and  leave  them  in  this  position  until  the  child  is  bom. 
This  cruelty  does  not  appear  to  affect  them  in  any  percep- 
tible manner,  and  they  recover  from  it  in  a  much  shorter 
time,  and  resume  their  avocations  sooner,  than  the  most  ro 


68  LABOR:   AN  ETHNOLOGICAL  STUDY. 

bust  white  women.^  The  natives  of  Ceram  hastily  construct 
a  rude  hut  of  leaves  and  brush  for  the  parturient  woman, 
and  an  old  hag,  who  assists  as  midwife,  ties  the  patient, 
with  her  arms  as  high  as  possible,  to  a  tree,  so  that  the 
balls  of  the  feet  barely  touch  the  ground,  whilst  she  herself 
takes  a  more  comfortable  position  before  the  parturient, 
and  receives  the  child  in  a  large  leaf,  a  mat,  or  an  old  piece 
of  cloth.  Labor  over,  the  young  mother  washes  herself,  or 
takes  a  bath,- and  immediately  returns  to  her  village  and  to 
work.^ 

3.     SUSPENDED. 

Not  unfrequently  the  negroes  in  our  southern  States 
still  follow  the  customs  brought  from  their  African  homes, 
or  merely  handed  down  by  tradition  ;  in  their  method  of 
delivery  they  do  not  vary  from  that  of  the  tribe  from  which 
they  sprang.  Occasionally  the  erect  posture  is  taken,  and 
a  graphic  description  of  such  a  labor  has  been  given  me, 
ds  witnessed  in  Louisiana,  A  negress  gave  birth  to  a 
child  while  hanging  on  to  the  limb  of  a  tree.  She  would 
raise  herself  from  the  ground  during  the  pains,  whilst  the 
assistant  who  was  with  her  took  charge  of  the  child  after  it 
was  born.^ 

In  some  portions  of  Finland,  among  the  Esthen,  as  well 
as  in  some  portions  of  Russia,  the  women  are  delivered  in 
a  similar  manner  while  hanging  to  a  cross-bar  ;  they  at- 
tempt, as  it  were,  to  shake  out  the  child.* 

We  have  the  authority  of  Father  Oc/i  tha.t,  in  Brazil,  the 
parturient  woman  occasionally  has  her  arms  tied  to  a  tree, 
while  she  is  waited  on  by  some  old  hags  until  the  delivery 
is  completed.^ 

In  some  portions  of  Germany,  though  the  instances  are 

^  Dr.  W.  J.  Hoffmann,  Miscellaneous  Ethnological  Observations 
among  the  Indians  in  Nevada,  Colorado^  and  Arizona,  p.  471.  Hay 
dens'  Survey,  1876. 

2  Captain  Schuize,  "  Ueber  Ceram,"   Ztschr.f.  EtJui.,  1877,  p.  120 

3  Dr.  A.  V.  Forquey,  of  St.  Louis. 
^  Kredel.     Ploss,  p.  43. 

^  Marr,  Nachr.  v.  Span.  Amerika,  i.,  202. 


POSTURE. 


09 


rare,  the  woman  is  delivered  suspended  in  the  arms  of  her 
husband,  who  seizes  her  from  behind  and  raises  her  up,  so 
that  she  is  bent  backward  to  such  a  degree  that  the  tips  of 
the  toes  barely  touch  the  ground.^ 


Fig.  8.    Southern  Negroes.     Suspended. 


The  Siamese,  who  use  massage  freely,  are  usually  deliv- 
ered in  the  dorsal  decubitus  ;    but  in  difficult  cases,  when 
even  tramping  upon  the  abdomen  is  not  attended  with  suc- 
cess, as  a  dernier  ressort,  they  suspend  the  patient  by  means 
^  Hohl,  Midwifery,  second  edition,  1862,  p.  444. 


70  i'AB OR:   AN  E THNOL O GICAL  S TUD Y. 

of  a  band  beneath  the  arms,  and  one,  sometimes  two,  of 
the  attendants  then  clasp  with  their  arms  the  body  of 
the  parturient,  and  suspend  themselves  also  ;  this  expe- 
dient seldom  fails  to  produce  a  rupture  in  some  direction, 
be  it  the  uterus,  the  perineum,  or  the  encephalon  of  the 
child. 

B.    INCLINED    POSITIONS. 

This  class,  which  we  shall  find,  by  far,  the  most  common 
among  civilized  and  savage  people,  ancient  and  modern,  I 
have  divided  into  four  kinds,  though  the  first  one  may  not, 
perhaps,  with  the  greatest  propriety,  be  called  an  inclined 
position. 

1.  The  erect,  sitting  posture. 

2.  The  squatting  position,  as  in  defecation. 

3.  The  kneeling  posture  and  its  modifications ;  and 
finally,  — 

4.  The  semi-recumbent  position,  whether  on  the  lap  of 
an  assistant,  in  a  chair,  on  the  floor,  or  in  bed. 

I.     SITTING    ERECT. 

I  hardly  know  whether  to  consider  the  erect  sitting  pos- 
ture as  an  inclined  or  an  upright  position,  but,  as  the  pelvic 
axis  is  certainly  more  inclined  than  in  the  standing  posture, 
and,  as  it  will  be  very  hard  to  draw  a  line  between  the  dis- 
tinctly erect  sitting  posture  and  the  somewhat  inclined,  I 
have  determined  to  place  it  among  the  inclined,  and  to  con- 
sider it  first  under  this  head,  because  it  is  most  nearly  re- 
lated to  the  perpendicular  or  upright.  Women  confined  in 
this  position  make  use  of  cushions,  stones,  stools,  or  mother 
earth  herself  ;  but  the  temptation  to  assume  a  somewhat 
reclining  position,  leaning  against  the  assistant  or  some 
other  support,  is  so  great,  that  it  is  difficult  to  say  with  pre- 
cision that  the  erect  sitting  posture  is  assumed,  as  the 
notes  upon  the  subject,  by  most  writers,  are  not  sufficiently 
clear.  I  can  find  but  one  distinct  description  of  a  labor  in 
which  it  is  stated  that  the  patient  was  confined  sitting 
upright,  and  that  this  is  the  usual  position  among  native 


POSTURE. 


71 


Australians,  the  weak  women  only  lying  down  when  in 
labor.  1 

The  Nayer  women,  of  Malabar,  are  confined  while  seated 
upon  a  cushion,  or  a  low  three-legged  stool  without  a  back, 
and  are  supported  by  the  midwife,  or  some  female  relative. 
As  is  so  common  among  savage  races,  they  then  bathe  in 
the  nearest  stream,  or  other  convenient  water,  immediately 
after  delivery,  and  resume  their  work,  as  far  as  is  permissi- 
ble, in  the  state  of  uncleanliness  in  which  they  are  consid- 
ered to  be  after  labor.^ 

In  a  similar  way  the  native  woman  of  Guatemala,  South 
America,  is  confined.  She  is  seated  on  the  ground,  sup- 
ported by  a  midwife,  who  presses  one  knee  into  the  small 
of  her  back.^ 

In  Calabar,  Africa,  the  same  position  is  assumed,  the 
woman  sitting  on  a  low  chair,  or  block,  while  the  midwife 
squats  in  front  of  her,  pressing  the  sides  of  the  abdomen.* 

On  the  Canary  Islands,  the  parturient  woman  sits  upon 
the  floor,  with  a  chair  or  other  support  beside  her,  upon 
which  her  arms  rest.  In  Astrakhan,  in  Russia,  she  sits  in 
a  similar  way  between  two  boxes  or  trunks,  upon  which  her 
arms  rest.^ 

A  sitting  position,  with  the  body  decidedly  bent  forward, 
was  observed  in  a  Sioux  squaw,  who,  like  her  sisters  among 
most  of  the  Indian  tribes,  sought  a  solitary  confinement 
upon  the  banks  of  a  stream.*^  The  position  of  this  woman, 
until  the  expulsion  of  the  child,  —  about  forty  minutes,  — 
was  cross-legged  -on  the  floor,  her  arms  crossed  over  her 
breast,  head  bowed,  and  the  body  bent  forward,  especially 

^  HookftY,  Journal  of  the  Londo7i  Ethnological  Society,  April,  1869, 
p.  68. 

2  Herr  N.  von  Miklucko-Macklay,  "  Anthropologishe  Notizen  gesam- 
melt  auf  einer  Reise  in  West  Mikronesien  und  Nord  Milanesien," 
Ztschr.f.  Ethn,  1876,  p.  126. 

3  Bernouilli,  Schweiz.  Ztschr.f.  Heilk.,  Bern,  186^],  i.  and  ii.,  p.  loo. 
Ploss,  Die  Lage  und  Stellung  der  Frau  ivdhrend  der  Geburt,  Leipzig, 
1872,  p.  20. 

*  He  wan,  Edinb.  M.  %  September,  1864,  p.  223. 

*  H.  Meyerson.     Ploss,  p.  20. 

6  Surgeon  B.  B.  Taylor,  U.  S.  A. 


72 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


during  the  pains  ;  the  legs  were  crossed  below  the  knee, 
and  in  such  a  manner  that  the  thighs  were  widely  sepa- 
rated. I  may,  perhaps,  add,  though  it  is  of  little  practical  in- 
terest, that  according  to  the  Egyptologist,  Professor  Ebers,  a 

hieroglyph  is  frequently 
found  on  some  of  the 
old  Egyptian  monuments 
which  represents  a  wom- 
an sitting  cross-legged, 
and  seems  to  represent 
the  act  of  expulsion.^ 

2.    SQUATTING. 

This  position  naturally 
follows  the  erect  sitting 
posture,  although  the 
body  is  always  inclined 
forward  to  a  certain  de- 
gree ;  it  is  hardly  to  be 
defined  with  exactness, 
yet  we  may,  in  a  general 
way,  consider  all  pos- 
tures as  squatting  which 
resemble  that  assumed  in  defecation.  Though  apparently 
inconvenient,  and  repugnant  to  the  refined  woman,  this 
position  is  certainly  the  most  natural  one  for  expulsion 
from  the  abdominal  or  pelvic  viscera,  and  will  certainly,  in 
many  cases,  facilitate  labor.  Thus  a  friend  relates  his  ex- 
perience :  A  colored  woman,  a  house  servant,  carefully 
reared,  who  had  undergone  several  very  difficult  labors,  in 
her  fourth  or  fifth  pregnancy,  feeling  a  little  uncomfortable, 
and  desiring  to  be  ready,  took  a  pail  and  went  to  a  pump 
for  water.  She  -carried  it  for  twenty  or  thirty  steps,  and, 
arriving  at  the  gate,  felt  violent  contraction.  She  set  the 
pail  down,  squatted,  and  was  delivered  of  her  child. 

\"  So  easily  she  yields  her  bosom's  load,  / 

You  'd  almost  think  she  found  it  in  the  road."  ^ 


Fig.  9.  —  Sioux  Squaw. 


^  Ploss,  p.  36. 


^  Dr.  Campbell,  of  Augusta,  Ga. 


POSTURE.  /^3 

In  other  confinements  she  had  assumed  the  squatting  posi- 
tion, and  was  easily  delivered. 

Then,  again,  he  tells  me  of  attending  a  lady  of  good 
position  in  society  in  two  labors.  "  In  her  first  labor, 
delivery  was  retarded  without  apparent  cause.  There  was 
nothing  like  impaction,  or  inertia,  yet  the  head  did  not 
advance.  At  every  pain  she  made  violent  efforts,  and 
would  bring  her  chest  forward.  I  had  determined  to  use 
the  forceps,  but  just  then,  in  one  of  the  violent  pains,  she 
raised  herself  up  in  bed  and  assumed  a  squatting  position, 
when  the  most  magic  effect  was  produced.  It  seemed  to 
aid  in  completing  delivery  in  the  most  remarkable  manner, 
as  the  head  advanced  rapidly,  and  she  soon  expelled  the 
child  by  what  appeared  to  be  one  prolonged  attack  of  pain. 
In  subsequent  parturition,  labor  appeared  extremely  painful 
and  retarded  in  the  same  manner ;  I  allowed  her  to  take 
the  same  position,  as  I  had  remembered  her  former  labor, 
and  she  was  delivered  at  once,  squatting." 

The  Irish,  also,  are  familiar  with  this  most  natural  of  all 
positions,  although  the  knee-elbow  position  is  more  common 
among  them.  A  striking  instance  is  related  to  me  of  a 
poor  Irish  woman  who  was  found  upon  a  vacant  lot  in  New 
York  city,  squatting  upon  the  ground,  endeavoring  to  ex- 
press the  placenta,  the  child  having  already  been  delivered 
in  the  same  position.^ 

Dr.  John  Williams,  physician  to  the  Green  Bay  Indian 
Agency,  seems  to  consider  with  great  favor  this  position  as 
assumed  by  the  Pawnee  Indians.  He  has  had  extensive 
experience  as  Agency  physician,  having  been  associated 
with  different  tribes  of  Indians  in  different  localities,  and 
he  does  not  think  that  climate  has  anything  to  do  with  the 
labor  of  the  parturient  woman.  He  says  :  "  I  am  satisfied 
that  the  Pawnee  Indian  women  are  far  more  exempt  from 
the  maladies  resulting  from  parturition  than  the  Menemo- 
nee,  Stockbridge,  or  Oneidas  of  Wisconsin.  Possibly  this 
may  be  attributed  to  the  position  assumed  during  labor. 
The  position  of  the  Pawnee  woman  in  parturition  is  gener- 
1  Dr.  F.  A.  Castle.     New  York. 


74: 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


ally  a  squatting  one  with  the  Indian  woman  who  assists  her 
squatting  at  her  back,  the  two  being  back  to  back,  and  the 
accoucheur,  who  is  generally  a  medicine  man,  in  front  of 
her  upon  his  knees,  with  a  gourd  in  one  hand,  which  he 
rattles  constantly,  and  a  pipe  in  his  mouth  which  he  smokes, 
blowing  the  smoke  under  the  clothes  or  covering  of  the  pa- 
tient until  after  the  delivery  of  the  child."  Evidently,  a 
warm  vapor  bath  to  soften  the  parts.  Precisely  the  same 
position  is  assumed  in  West  Micronesia,  where  the  mother, 
during  the  expulsive  pains,  assumes  a  squatting  —  half-sit- 


Fig.  10.  —  Pawnee  Labor. 

ting,  half-lying  position,  her  back  resting  against  the  back 
of  an  assistant.^  So  also  the  Wazequa  women  squat  during 
labor.2 

Others  of  our  Indians,  than  those  already  mentioned 
assume  this  position,  with  slight  variations.  Thus  ^  the 
!Nez-Perces  and  Gros-Ventres  :    during:  the  first  stages  of 


^  Herr  von  Micklucko-Macklay,  Ztschr.  f.  Ethn.,   1876,  page  105, 
"  Anthropologische  Notizen,"  etc. 

^  J.  M.  Hiklebrandt,  "  Ethnographische  Notizen."   Ztschr./.  Ethn. 
1878,  vol.  X.,  page  394. 

•  Major  Chas.  R.  Greenleaf,  Surgeon  U.  S.  A. 


POSTURE. 


75 


labor  the  woman  is  in  a  stooping  posture,  v/ith  the  buttocks 
resting  on  the  heels.  An  assistant  places  herself  back  of 
the  patient,  clasping  her  body  with  her  arms,  letting  the 
fingers  reach  below  the  ribs  over  the  base  of  the  uterus, 
making  steady  pressure  backwards  and  outwards  during 
the  pains.  During  the  third  stage,  or  expulsion  of  the 
child,  the  patient,  however,  lies  down  indifferently  on  either 


Fig.  n. —  Squatting  Posture  of  the  Tonkawas. 


side  or  on  the  back,  while  the  pressure  by  the  hands  of  the 
assistant  is  kept  up  continuously,  if  on  the  side  ;  if  on  the 
back,  the  assistant  remains  by  the  side  of  the  patient  and 
keeps  up  the  pressure  in  the  before-mentioned  directions. 
In  difficult  labors  the  knee-elbow  position  is  assumed.  The 
Tonkawas  retain  the  squatting  posture  until  after  the  ex- 
pulsion of  the  child  :i  so  also  the  Coyotero  or  White  Moun- 
tain Apaches  :  "The  Coyotero  squaw  occupies  any  position 
she  pleases,  generally  standing  or  walking,  until  bearing 

1  Wm.  R.  Steinmetz,  Surgeon  U.  S.  A. 


76  LABOR:   AN  ETHNOLOGICAL  STUDY. 

down  pains  supervene,  when  she  assumes  the  squatting 
posture  until  after  the  birth  of  the  child  and  placenta ;  but 
in  tedious  cases  the  patient  is  suspended  in  a  half-kneeling 
position  by  a  lariat  from  the  limb  of  a  tree  and  the  child 
stripped  out,  as  it  were."  ^ 

A  slight  variation  of  this  position  is  found  among  some 
of  the  larger  branches  of  the  Sioux  Nation,  the  Brul^, 
Loafer,  Ogallala,  Wazahzah,  and  Northern,  who  stoop,  and 
with  their  hands  grasp  deer-thongs  attached  to  stakes  driven 
into  the  ground,  against  which  they  pull.^ 

The  Mexican  half-breeds,  in  New  Mexico  and  vicinity, 
sometimes  suspend  a  cord  from  the  ceiling,  with  a  stick  at- 
tached, so  that  the  women  can  seize  it  in  a  half-upright, 
squatting  position.^  The  same  we  find  among  the  Kal- 
mucks upon  the  borders  of  China  and  Russia,  and  not  un- 
frequently  during  the  third  stage  of  labor  they  squat  lowei 
in  bed  on  their  heels,  whilst  holding  with  their  hands  on  to 
a  pole,  the  abdomen  being  pressed  from  behind  by  an  as- 
sistant.* 

The  squatting  position,  with  the  body  bent  forward,  is 
assumed  by  the  women  of  Southern  Arabia  in  the  vicinity 
of  Aden,  who,  however,  rest  their  hands  upon  the  ground 
instead  of  crossing  them  upon  the  breast,  as  the  squaw 
does.  But,  among  these  people,  as  among  so  many  of  our 
Indians,  and  the  tribes  of  Africa,  massage  is  freely  resorted 
to  if  any  obstruction  seems  to  prevent  the  labor,  sometimes 
with  the  hands,  sometimes  with  the  feet  ;  in  the  latter  case, 
the  assistant,  standing  with  her  heels  upon  the  lower  ribs, 
works  the  fundus  of  the  uterus  with  her  toes.^ 

Every  people  varies  its  customs  a  little.  The  Polynesian 
and  Australian  negresses  squat,  as  in  defecation,  over  a 
small  hole  which  they  have  scratched  in  the  ground  for  the 
reception  of  the  child.^     Floss  also  states,  upon  the  author- 

1  Walter  Reed,  M.  D.,  Asst.  Surgeon,  U.  S.  A. 

2  W.  H.  Faulkner,  M.  D.  s  h.  R.  Tilton,  Surgeon  U.  S.  A. 
*  Krebel,  Volks  Med.,  page  55.     PIoss,  page  43. 

5  Hildebrandt.     Ztschr.  f.  Ethn.,  1878,  vol.  x.,  p.  394. 
^  Ploss,  p.  42. 


POSTURE. 


77 


ity  of  Dr.  Pollak,  physician  to  the  Shah,  that  the  Persians 
are  sometimes  confined  squatting  on  the  ground,  cross- 
legged,  sometimes  kneeling  or  sitting  cross-legged  ;  but  it 
seems  that  the  most  popular  position,  and  the  one  which 
appears  to  me  to  be  far  the  most  natural,  and  which  bears  a 
strong  resemblance  to  our  semi-recumbent  position,  whether 
in  bed,  or  in  the  obstetric  chair,  or  on  the  husband's  lap,  is 
the  squatting  position,  as  represented  in  the  illustration  of 
a  woman  with  her  legs  apart,  supporting  herself  upon  her 
arms  on  a  pile  of  three  bricks,  which  she  has    placed  on 


Fig.  12.    Obstetric  Position  of  the  Persians. —  From  Ploss  (after  Pollak  and  Haentsche). 


either  side  of  her.  In  this  position  we  have  a  remarkable 
illustration  of  the  points  which  are  developed  in  every  per- 
fect obstetrical  position,  namely,  absolute  relaxation  of  the 
muscles  of  the  lower  extremities  and  the  pelvis,  and  sepa- 
ration of  the  limbs,  in  order  to  allow  space  for  the  passage 
of  the  child.  The  strain,  if  there  be  any,  being  upon  the 
muscles  of  the  arms  and  the  chest. 

The  Zuiii  women  of  New  Mexico  are  delivered  in  this 
same  position,  which  we  may  call  a  squatting  one,  and 
which  is  described  to  me  as  "  half  standing  and  half  sit- 
ting;" an  attendant  supports  the  patient,  and  facilitates 
expulsion  by  pressing  the  abdomen  from  above  downward.' 

1  T.  F.  Ealy,  M.  D. 


78  ^^S OR:   AN  B THNOL O GICAL  S TUD T. 

Ill  the  neighboring  Laguna  Pueblo  pretty  much  the  same 
custom  is  followed.  In  the  early  stages  of  labor  the  pa- 
tient stands,  as  she  urinates,  with  her  hands  on  her  knees  ; 
later,  she  stands  up,  supported  by  a  woman  on  each  side, 
or  a  rope  is  cast  over  a  joist  of  the  roof  and  allowed  to 
hang  down  in  a  wide  loop  ;  she  puts  her  breast  in  the  loop 
and  holds  on  to  the  ascending  ropes,  her  feet  on  the  floor, 
in  a  half-sitting  (squatting)  posture,  thus  obtaining  great 
expulsive  force ;  if  tired  and  worn,  she  lies  down.  All 
these  positions  are  assumed  at  the  choice  of  the  patient  or 
the  advice  of  her  assistants,  two  to  six  in  number.^ 

3.    KNEELING. 

The  kneeling  posture,  like  some  other  positions  which 
appear  to  us  peculiar,  is  a  historical  one.  It  is  referred  to 
in  the  Bible,  as  well  as  by  the  Roman  poets.  It  was  taught 
in  ancient  Rome,  among  the  Arabs,  and  in  Germany  dur- 
ing the  Middle  Ages,  and  definite  rules  were  laid  down  for 
the  circumstances  under  which  it  should  be  resorted  to. 
At  this  present  day  it  is  still,  at  times,  adopted  in  the  rural 
districts  of  our  own  States,  and  more  frequently  than  we 
should  suppose  in  our  cities.  It  is  that  position  which  is, 
perhaps,  most  universal  among  our  Indians,  that  is,  among 
what  we  may  call  the  blanket  Indians,  those  who  have  not 
yet  partially  succumbed  to  the  advances  of  eastern  civiliza- 
tion. Some  of  our  ablest  obstetricians.  Fellows  of  this  So- 
ciety, who  have  given  me  their  opinions  upon  the  kneeling 
posture  in  labor,  differ  in  their  views  in  regard  to  its  ad- 
vantages and  disadvantages  ;  to  one  it  seems  physiologi- 
cally correct,  and  appears  most  practically  to  favor  the  ex- 
pulsion of  the  child,  whilst  it  is  frowned  upon  by  another 
as  liable  to  be  followed  by  hemorrhage.  We,  however,  do 
not  hear  of  this  as  a  frequent  occurrence  among  the  In- 
dians, where  the  position  is  so  common ;  in  fact,  w^e  neither 
hear  of  this  nor  any  other  accident  consequent  upon  labor, 
not  even  of  prolapse,  which  might  be  supposed  to  follow  ; 
probably,  because  the  position  is  only  assumed  during  the 
1  John  Menaul,  U.  S.  Teacher. 


POSTURE. 


79 


jtt^vent  of  the  more  severe  pains,  and  in  the  very  last  stage 
of  labor. 

If  I  may  make  a  broad  assertion,  the  kneeling  posture 
seems  most  common  among  the  red  and  yellow  races  ;  our 
Indians  mainly  being  delivered  kneeling,  with  the  body  in- 
clined forward  ;  whilst  the  Mongolians  seem,  as  a  rule,  to 
retain  the  body  more  erect.  I  have  classified  the  kneeling 
positions  as  follows  :  — 

{a.)  The  body  inclined  forward. 

{b.)  This  position  overdone  ;  that  is,  with  the  body  thrown 


ijjS^'i 


Fig.  13. —  Southern  Negress. 

completely  forward,  the  patient  resting  on  the  hands  and 
knees,  or  knees  and  elbows. 

{c.)  The  body  erect  or  inclined  backward,  sometimes 
clinging  to  a  rope. 

{d.)  Kneeling  postures,  where  precise  descriptions  are 
lacking:. 


a.    Kneelifig,  the  Body  inclined  Forward. 

It  is  the  custom  of  most  writers  upon  this  subject  to 
refer,  like  Legros,^  Goodell,  Ploss,  and  others,  to  the  labor 

^  "De  la  position  de  la  Ferame  pendant  raccouchement,"  Gaz.  des 
hop.^  1864,  p.  133. 


80  LABOR:   AN  ETHNOLOGICAL  STUDY. 

of  Latona,  whom  Homer,  in  his  hymn  to  Apollo,  represents 
as  being  delivered  whilst  kneeling  upon  the  soft  meadow, 
clasping  a  palm  tree.  A  somewhat  more  precise,  though 
less  poetic,  description  is  given  me  of  the  labor  of  a  Georgia 
negress :  the  physician  being  called  in  great  haste,  found 
his  patient  kneeling  on  a  mat,  placed  on  the  floor,  with  her 
head  and  elbows  resting  on  the  seat  of  a  rocking-chair,  the 
thighs  perpendicular,  and  the  body  nearly  horizontal.  The 
head  had  been  born,  but  the  shoulders  resisted.  Observ- 
ing his  patient  for  a  few  moments,  he  found  that  during  the 
pains  her  body  would  move  backward  so  that  her  buttocks 
rested  upon  her  heels,  whilst  in  the  interval  she  would 
glide  forward  again,  so  that  the  thighs  became  perpendicu- 
lar and  the  body  horizontal.  By  his  assistance,  she  was  de- 
livered of  an  enormously  large  child. ^ 

In  a  previous  labor  she  had  been  confined  in  a  similar 
position,  resting  head  and  arms  in  the  lap  of  her  mistress  ; 
precisely  the  same  position  which  the  squaws  of  the  Um- 
pgua  tribe,  in  Oregon,  are  in  the  habit  of  assuming.  Let 
us  look  in  upon  a  scene  of  this  kind. 

The  patient  was  found  in  a  lodge,  roughly  constructed  of 
lumber  and  drift-wood  ;  the  place  was  packed  to  suffocation 
with  men  and  women,  the  stifling  odor  from  sweat  and 
smoke  and  stench  of  whale  oil,  rendered  the  lodge  unen- 
durable for  more  than  a  few  moments  together.  The  par- 
turient, situated  in  the  centre  of  the  place,  was  entirely 
naked  excepting  a  covering  by  a  dirty  blanket,  which  was 
thrown  across  her  loins.  Her  head  and  shoulders  were 
supported  in  the  lap  of  an  old  squaw,  while  her  thighs  were 
stoutly  pressed  against  the  pelvis  by  a  squaw  on  each  side, 
who  were  engaged  in  crowding  the  uterus  downward  in  a 
brutal  manner  with  their  clenched  fists,  occasionally  giving 
it  a  lateral  motion  ;  another  squaw  sat  between  her  knees, 
with  her  hands  under  the  blanket,  ready  to  receive  the 
child  when  it  came.  The  crowd  in  the  lodge  all  the  while 
kept  up  a  deafening  din  by  crying,  shouting,  pounding  on 
tin  vessels,  and  thumping  up  against  the  roof  with  poles ; 
1  Dr.  H.  F.  Campbell. 


POSTURE.  81 

occasionally  the  attendants  at  the  patient's  side  would  make 
passes  over  her  in  the  mesmeric  style,  and  spurt  sprays  of 
water  upon  her,  after  the  fashion  of  Chmese  laundrymen.^ 

Many  of  the  Indian  tribes  follow  this  custom,  the  partu- 
rient woman  assuming  a  kneeling  position,  head  and  arms 
resting  in  the  lap  of  an  attendant,  or  upon  any  convenient 
support :  a  stump,  box,  bed,  or  chair ;  so  the  tribes  of  the 
Quapaw  Agency,  the  Peorias,  Shawnees,  Wyandots,  Otta- 
was,  and  Senecas.'-^ 

The  Indians  of  the  Cattaraugus  Reservation  are  delivered 
in  the  same  way,  assuming  this  position  just  before  the  ex- 
pulsion of  the  child,  whilst  in  the  earlier  stages  they  sit  or 
walk  about  as  they  please.^  So,  also,  the  Klatsops  of  north- 
western Oregon,  who,  however,  retain  the  body  more  erect, 
as  a  young  woman  assistant  stands  behind  the  parturient 
and  clasps  her  under  the  arms  and  around  the  breast,  sup- 
porting the  patient  and  forcibly  holding  her  up.'^ 

The  whites  equally  resort  to  this  position  ;  thus  I  hear 
of  its  observance  in  the  western  and  southwestern  portions 
of  Missouri.  Dr.  Willis  P.  King,  of  Sedalia,  writes  me  that 
he  has  found  quite  a  number  of  cases  where  the  women  de- 
sired, during  the  last  part  of  the  second  stage,  to  get  up 
and  kneel  by  a  chair  ;  and  he  says  that  all  the  women  who 
have  been  in  the  habit  of  being  delivered  in  this  way  were 
Pennsylvanians,  of  the  Pennsylvania  German  stock,  or,  at 
least,  that  the  suggestion  had  come  from  a  Pennsylvania 
woman.  Since  he  has  seen  a  woman  flood  almost  to  syn- 
cope after  delivery  in  this  position,  he  condemns  it  severely. 

I  am  a  little  astonished  to  see  this  position  mentioned  as 
originating  in  this  country  among  the  Pennsylvania  Ger- 
mans, because  the  only  reference  that  I  can  find  to  the 
kneeling  posture  among  the  Germans  (and  we  cannot  in  re- 
ality call  the  Fins  Germans)  is  by  Holst,^  who  says  that  the 
Esthen,  in  difficult  cases,  seek  to  hasten  delivery  by  assum- 

1  E.  P.  Vellum,  M.  D.,  Surgeon  U.  S.  A. 

2  F.  A.  Bickford,  M.  D.  »  a.  D.  Lake,  M.  D. 
*  J.  Murray  Dickson,  M.  D. 

^  Beitr.  z.  Gyncek.  zi.  Geburisk.,  vol.  ii.,  p.  114. 


82 


LABOR  :   AN  E THNOL O GICAL  S TUD  T. 


ing  the  kneeling  posture,  by  suspending  the  woman,  or 
placing  her  upon  her  husband's  lap.  Among  the  early 
Scotch  and  English,  however,  it  was  more  common,  at  least 
so  it  is  told  by  Spence,  in  his  "  System  of  Midwifery,"  ^  who 
says  that  some  women  are  inclined  to  be  delivered  kneeling 
down  beside  a  chair  or  bed,  leaning  on  it  with  their  elbows 
or  heads.     Irish,  of  the  laboring  classes  in  Massachusetts, 


Fig.  11.  —  Blackfoot  Squaw 

are  still  occasionally  delivered  in  this  position,  if  left  to 
themselves.^  The  Armenians,  and,  in  Greece,  the  Pelas- 
gians,  are  delivered  in  the  same  position,  kneeling,  hands 
and  arms  resting  on  a  chair,  whilst  the  midwife  is  seated 
behind  the  patient  to  receive  the  child. ^ 

Not  having  the  convenience  of  a  chair  always  at  hand 


*  Edinburgh,  1784,  pp.  148-149. 

*  Dr.  Damean  George.     Ploss,  p.  40. 


2  C.  A.  Wilcox,  M.  D. 


POSTURE.  gg 

but  seeking  instinctively  to  further  labor  by  this  same 
kneeling  position,  witn  the  body  inclined  forward,  the  North 
American  Indian  seizes  a  staff  or  tent-pole.  This  is  true 
of  some  Indians  belonging  to  the  Sioux  Nation,  —  the 
Blackfeet,  the  lower  and  upper  Yankton-ais,  and  Uncapa- 
pas.i  In  these  tribes  I  am  told  that  the  parturient  woman 
is  generally  assisted  by  an  old  squaw,  the  recognized  mid- 
wife of  the  camp,  or  by  a  female  relation.  She  assumes  the 
kneeling  posture,  —  knees  apart,  body  incHned  forward, 
hands  resting  upon  a  staff  or  t^-pee  pole,  head  resting  on 
the  arms.  Sometimes  the  arms  rest  on  a  trunk,  or  other 
suitable  object  to  lean  upon.  The  staff  referred  to  is  known 
as  the  "  Honpe,"  an  instrument  used  for  digging  the  Pomme- 
blanc,  or  wild  Indian  turnip,  and  may  be  regarded  as  the 
original  support  used  during  delivery.  This  posture  is 
maintained  during  the  expulsion.  The  same  is  true  of  the 
Caddo,  Delaware,  Kiowa,  and  Comanche  Indians.^  "The 
patient  generally  walks  about  the  lodge  during  the  first 
stage  of  labor,  but  as  the  second  stage  begins  she  assumes 
the  kneeling  position,  and  holds  to  a  stake  driven  in  the 
ground  in  front  of  her." 

The  same  custom  is  observed  among  the  Comanches  and 
the  Indians  of  the  Uintah  Valley,  who,  however,  are  not 
confined  in  their  te-pee  but  in  a  temporary  enclosure  near 
by.  The  accompanying  cut  represents  a  Comanche  squaw 
in  labor,  and  in  order  that  it  may  be  fully  understood  I  will 
give  some  of  the  details  of  this  accouchement  from  the  ex- 
tremely interesting  description  of  Major  W.  H.  Forwood, 
Surgeon  U.  S.  A., 'who  was  in  attendance  and  kindly  fur- 
nished the  sketch  :  "  A  short  distance  outside  the  camp, 
and  in  the  rear  of  the  patient's  family  lodge,  a  shelter  had 
been  constructed  of  green  boughs,  six  or  seven  feet  high, 
by  making  holes  in  the  hard  ground  with  a  wooden  peg,  and 
setting  up  brush  or  bushes,  with  the  leaves  on,  around  the 
circumference  of  a  circle  about  eight  feet  in  diameter.    An 

1  Surgeon  L.  M.  Maus,  U.  S.  A..  Fort  Yates,  D.  T. 
^  Dr.  L.  L.  McCabe,  Physician  to  the  Kiowa,  Comanche,  and  Wa- 
chita  Agency,  Maj.  iM.  Barber,  U.  S.  A. 


84 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


entrance  was  provided  by  breaking  the  circle  and  overlap- 
ping the  two  unjoined  ends ;  in  a  line  outside  the  entrance 


were  three  stakes,  ten  paces  apart,  set  firmly  upright  in  the 
ground,  four  feet  high. 

Inside  the  shelter  were  two  rectangular  excavations  in  the 
grass-covered  soil,  about  twelve  by  sixteen  inches,  with  a 


POSTURE.  85 

Stake  at  one  end  of  each  ;  in  one  of  these  holes  was  a  hot 
stone,  and  in  the  other  a  little  loose  earth  to  receive  any 
discharge  that  might  take  place  from  the  bladder  or  bowels  ; 
the  ground  about  was  strewn  with  a  few  aromatic  herbs  ; 
sometimes  a  lariat  secured  to  a  limb  overhead  may  take  the 
place  of  the  stakes  to  hold  to  during  a  pain. 

I  found  my  patient  walking  with  her  assistant,  a  female 
relative,  up  and  down  the  line  of  stakes  outside  the  shelter, 
stooping  now  and  then  to  kneel  at  the  nearest  stake  and 
grasping  it  with  both  hands  during  a  pain  ;  most  of  her  time 
was  spent  in  this  way,  outside  the  enclosure  ;  occasionally 
she  would  enter  to  kneel  over  the  hot  stones  or  loose 
earth.  During  each  pain  she  knelt  down  close  to  one  of 
the  stakes,  bringing  the  front  of  her  feet  and  legs  against 
the  ground  and  her  knees  a  little  apart,  the  body  bent  for- 
ward, face  turned  down,  or  sometimes  up,  at  the  severest 
part  of  the  pain,  and  the  hands,  one  above  the  other,  grasp- 
ing the  stake  on  about  a  level  with  the  head.  The  assist- 
ant stood  behind,  astride  of  or  between  the  patient's  feet, 
and  stooping  over,  passed  her  arms  around  the  body  until 
her  hands  were  brought  over  the  front  and  lower  part  of 
the  patient's  abdomen  ;  in  this  position  she  performed  sev- 
eral manipulations  with  the  palms  of  her  hands  and  lin- 
gers, while  the  pain  lasted,  such  as  rubbing,  kneading,  etc., 
but  most  frequently  a  quick  jerking  or  shaking  upward 
movement,  something  like  that  of  shaking  a  pillow  into  its 
case.  The  patient  never  assumed  a  recumbent  position, 
and  the  moment  the  placenta  escaped  she  sprang  up, 
buckled  on  a  stout  leather  belt,  mingled  with  the  crowd  and 
soon  disappeared,  without  apparently  taking  the  slightest 
notice  of  her  child." 

The  Indians  of  the  Uintah  Valley  Agency,  Utah,  observe 
the  same  customs  with  this  exception,  that  they  keep  a  ket- 
tle of  hot  water,  boiling,  within  the  enclosure  or  "  Wick- 
e-up,"  of  which  the  patient  takes  frequent  and  copious 
draughts  during  the  labor,  and  as  soon  as  the  child  is 
expelled  she  continues  drinking  freely  of  the  hot  water, 
rises  to  her  feet,  places  a  folded  cloth  to  her  abdomen,  and 


8 6  J-^^ OR:   AN  E THNOL O GICAL  S TUD T. 

leaning  forward  over  a  short  stake,  rests  her  body  upon  it, 
thus  exerting  considerable  pressure  over  the  hypogastric  re- 
gion, which  is  supposed  to  favor  the  expulsion  of  the  pla- 
centa.i 

The  natives  of  New  Zealand  kneel  down  upon  a  mat, 
the  knees  about  two  feet  apart,  the  hands  resting  on  a  tree 
or  stick,  or  clutching  some  hard  substance,  while  if  help  is 
needed,  the  arms  are  twined  about  the  knees  of  an  assist- 
ant in  order  to  press  them  against  the  fundus  of  the  womb.^ 

The  Dakota  woman  assumes  a  kneeling  position  during 
labor,  unless  extreme  weakness  prevents ;  she  supports  her- 
self by  a  post  driven  into  the  ground,  or  any  convenient 
means  of  support  ;  the  recumbent  position,  they  think,  re- 
tards the  progress  of  labor. ^ 

The  rather  vague  information  to  be  obtained  from  the 
Cheyennes,  Arapahoes,  and  Eastern  Apaches  was  to  the 
effect  that  the  parturient  woman,  as  among  so  many  of  the 
Indian  tribes,  retires  to  the  bush,  where,  if  the  labor  is  a 
normal  one,  she  is  delivered  without  any  assistance,  the  po- 
sition assumed  being  upon  her  knees,  occasionally  a  reclin- 
ing one.  Dr.  C.  P.  Allen  writes  me  concerning  the  Chippe- 
was,  from  the  White  Earth  Indian  Agency,  that,  if  the 
parturient  is  of  the  wild  or  blanket  Indians,  a  quantity  of 
dry  grass  is  spread  on  the  ground  in  the  t^-pee,  or  house, 
if  they  have  any  ;  a  pole  six  to  ten  feet  long  and  three  to 
four  inches  in  diameter  is  placed  on  the  backs  of  chairs  or 
fixed  across  one  corner  of  the  room  about  the  height  of  a 
chair,  behind  which,  with  it  across  her  chest,  the  woman 
rests  on  her  knees  during  the  pains,  sitting  down  in  the  in- 
terval. Those  who  are  partly  civilized  assume  a  somewhat 
similar  position  but  use  straw  overlaid  by  quilts  or  blankets. 

I  would  here  call  attention  to  the  fact  that  the  Chippewa 
woman  seems  to  draw  horizontally  upon  this  cross-bar  and 

1  Frank  S.  Bascom,  M.  D. 

2  Brit,  and  For.  Med.-chir.  Rev,  Lond  ,  1855..  vol.  xv.,  page  525. 
Hooker,  Journal  of.  the  Ethnological  Society.,  of  London,  1869,  page 
69.     Goodell,  page  674. 

8  Dr.  T-  W.  Cook,  Yankton  Agency. 


POSTURE.  87 

not  to  rest  herself,  or  raise  herself,  as  do  those  Indians  who 
support  themselves  by  a  staff  or  pole.  An  Indian  interpreter, 
F.  F.  Gerard,  who  has  spent  some  thirty  years  among  the 
Indians,  especially  the  Rees,  Gros-Ventres,  and  Mandans, 
and  has  had  a  good  deal  of  practice  in  their  camps,  writes 
me  from  Fort  Abraham  Lincoln,  that,  \n\.\\.  the  assistance 
of  several  women,  the  parturient  is  confined  in  a  kneeling 


Fig 


16.  — Chippewa  Labor.     Kneeling  inclined  backwards 


posture,  her  head  resting  on  her  arms,  which  are  crossed 
upon  her  bosom,  and  raised  about  fifteen  inches  from  the 
ground  :  a  large  piece  of  skin  is  placed  upon  the  ground  or 
a  blanket  is  used,  and  three  or  four  inches  of  dirt  are 
strewn  upon  the  skin  or  blanket,  then  another  piece  of  skin 
or  blanket  is  placed  over  this  for  the  woman  to  kneel  upon, 
the  head  upon  the  edge  of  the  bed.  This  position  is  as- 
sumed during  every  pain   until   the  delivery  takes   place. 


88 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


This  is  a  kneeling  position  with  the  body  so  far  inclined  for- 
ward that  it  approaches  the  knee-hand,  knee-chest,  knee- 
elbow  posture,  to  which  we  next  come. 

From  a  very  instructive  letter,  recently  received  from 
Dr.  N.  Kauda,  of  Tokio,  I  see  that  the  Japanese  are  not 
unfrequently  delivered  in  a  kneeling  posture ;  the  descrip- 


FiG.  17.  —  UraJTiework  formerly  in  use  in  Japan  for  the  support  of  the  parturient  in  a  kneeling 
'"*.,  posture. 

tion  of  the  labor  is  as  received  from  the  mouth  of  one  "  igno- 
rant of  the  modern  laws  of  obstetrics."  During  labor  and 
the  expulsion  of  the  child  the  woman  is  in  a  (sitting)  kneel- 
ing posture,  i.  e.,  the  body  supported  on  the  tips  of  the  toes 
and  thq  knees  ;  the  reason  for  this  is  to  prevent  the  rush  of 
blood  to  the  head.  The  body  is  bent  forward,  and  the  pa- 
tient supports  herself  by  seizing  hold  of  a  midwife,  who 
moreover  assists  by  rubbing  her  abdomen.  This  is  in  case 
she  can  afford   to  call  in  two  midwives,  as  a  more  skillful 


POSTURE. 


89 


one  is  needed  to  take  charge  ot  the  labor.  As  a  rule  the 
inferior  assistant  is  dispensed  with,  and  a  framework  about 
one  foot  and  a  half  square  is  used  as  a  convenient  support 
for  the  patient  to  hold  to. 

Fifty  years  ago  the  patient  was  supported  in  her  posi- 
tion and  the  labor  conducted  in  a  framework  (Fig.  17),  but 
now  ordinary  articles  of  bedding  are  piled  up  to  support 
the  back  (Fig.  18),  as  seen  in  the  figure  which  represents 
the  posture  just  after  delivery,  and  in  this  upright  position 


Fig.  is.  —  Sitting  Posture  of  the  Japanese  ;  customary  in  Childbed. 

the  patient  remains  for  some  three  days,  when  gradually 
the  prop  is  removed  from  behind  her  back  until  finally  she 
is  lying,  as  usual,  with  her  head  on  but  one  pillow. 


(b.')  Knee-Hand  or  Knee-Elbow  Position. 

The  knee-elbow  position  seems  of  old  to  have  been  rec- 
ommended by  the  ablest  obstetricians  for  very  stout  per- 
sons. Thus  Soranus,  and  later  the  Arab,  Jahiah  Ebu  Ser- 
apion,  and  Rhazes,  who  lived  in  the  first  half  of  the  ninth 
century,  advises  the  knee-elbow  position  under  these  cir- 


90  LABOR :  AN  E THNOL  O GICAL  S TUB  Y. 

cumstances ;  so,  also,  later,  among  the  Germans,  Roesslin^ 
tells  us  that  this  same  treatment  of  fat  women  is  found  in 
the  works  of  Hippocrates,  Galen,  Paul  of  ^gina,^  Aetius,^ 
and  was  used  by  most  of  the  "  modern  ancients."  Nor  was 
it  confined  to  remote  times  ;  for  in  some  portions  of  Rus- 
sia, Greece,  and  Turkey  women  are  yet  confined  in  this 
way. 

In  1779,  Hopkins  objected  to  the  lateral  position  and 
urged  that  the  position  on  the  hands  and  knees  was  the 
best.^  Denman  was  of  opinion  that  "  this  posture  is  in- 
stinctively sought  by  unassisted  women."  ^  Whilst  in  1791, 
that  shrewd  observer  Charles  White  quoted  Denman  ap- 
provingly, and  argued  that  the  "  knee-elbow  position  in 
natural  labor  prevented  too  great  a  pressure  on  the  peri- 
neum." ^  According  to  Ramsbotham,'^  "  the  peasantry  of 
Ireland  placed  themselves  upon  their  hands  and  knees,  and 
in  Cornwall  it  is  difficult  to  persuade  the  woman  in  labor 
to  take  any  other  posture  than  standing  or  on  her  knees." 
It  is  interesting  to  see  how  people  carry  these  customs, 
which  have  been  traditional  among  them  for  ages,  across 
the  seas. 

We  have  seen  the  southern  Negroes  following  the  Afri- 
can ways,  and  the  same  may  be  observed  among  the  Welsh, 
the  Irish,  and  Germans  ;  thus,  Dr.  H.  C.  Yarrow  tells  me 
that  he  had  a  patient  once,  a  Welsh  woman,  who  insisted  on 
crawling  on  hands  and  knees  while  the  pains  were  pro- 
gressing, and  who  informed  him  that  in  Wales  women  fre- 
quently assumed  this  position  or  were  delivered  sitting  upon 
the  laps  of  their  husbands.  Irish  women,  who,  as  I  am  in- 
formed by  several  correspondents,*  are  in  this  country  de- 
livered in  the  hand  and  knee  position,  assert  that  this  is 

1  Goodell,  page  675. 

2  Lib.  iii.,  cap.  Ixii.,  76. 

^  De  Conceptus  et  Partus  Ratione,  cap.  22. 
■*  7"-^!?  Accoucheur^ s  Vade  Mecum. 

*  Archives  of  Midwifery,  London,  1792,  part  i.,  page  58. 

*  Management  of  Pregnant  Lyiiig-iii  Wometi,  London,  1791,  p.  104. 
'  Second  edition,  page  122. 

*  Dr.  Baldwin,  of  Columbus,  Ohio. 


POSTURE.  91 

frequently  resorted  to  by  women  of  their  nationality  abroad. 
Some  of  our  ablest  obstetricians  consider  the  knee-elbow 
position  a  decidedly  favorable  one  for  version.  Dr.  Camp- 
bell, of  Augusta,  had  a  most  successful  case  of  this  kind 
which  he  described  and  which  should  have  been  published 
in  the  "Transactions  "  of  this  Society,  but  by  some  accident 
was  mislaid  ;  he  seems  to  think  that  when  the  woman  is  in 
labor  the  contents  of  the  pelvic  cavity  are,  by  this  position, 
relaxed  in  a  most  remarkable  manner,  making  it  very  favora- 
ble for  version.  Dr.  Parvin  of  Indianapolis  has  published 
a  similar  case,  which  has  deservedly  excited  attention.  These 
learned  gentlemen,  however,  need  not  claim  any  credit  to 
themselves,  as  the  untutored  redskin  now  does,  and  proba- 
bly has  for  centuries  done,  the  same  thing.  The  Cheyenne 
and  Arapahoe  squaws,  who  usually  assume  the  dorsal  de- 
cubitus, seek  a  change  of  position  in  case  of  protracted  la- 
bor, and  not  unfrequently  the  knee-elbow  position  to  facili- 
tate or  hasten  labor.^ 

Major  Charles  R.  Greenleaf,  surgeon  U.  S.  A.,  informs  me 
that  the  Nez-Perces  and  Gros-Ventres  women,  who  in  or- 
dinary labor  are  confined  in  a  stooping  posture,  in  cases 
where  labor  is  protracted  assume  the  knee-elbow  position, 
whilst  the  patient's  abdomen  is  encircled  by  a  broad  belt, 
upon  which  force  is  exerted  by  assistants,  placed  on  either 
side  of  the  patient,  who  scrupulously  direct  this  force  back- 
wards and  downwards  during  pains.  The  doctor  himself 
witnessed  such  a  case  of  protracted  labor  in  a  Gros-Ventre 
squaw,  a  primipara,  who  assumed  the  ordinary  knee-elbow 
position  and  about  whose  abdomen  a  belt,  often  called  the 
"  squaw-belt,"  was  placed. 

The  pressure  exercised  by  the  "  squaw-belt "  among  the 
Gros  Ventre  Indians  is  supplied  by  the  pillow  among  the 
Creeks,  and  the  encircling  arms  of  an  assistant  among  the 
Kootenais,  whose  labors  are  conducted  in  a  most  peculiar 
fashion,  the  parturient  taking  the  knee-elbow  position  ;  she 
is  on  her  knees,  the  face  touching  the  ground ;  hands,  one 
above  the  other,  grasping  a  pole  planted  in  the  ground, 
1  J.  H.  Bannister,  M.  D. 


92 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


head  couching  the  hands  ;  legs  apart.  A  male  assistant 
stands  astraddle  of  the  patient,  over  her  buttocks,  his  hands 
clasped  around  her  waist  ;  during  each  pain  he  pulls,  thus 
making  pressure  on  the  abdomen.^ 

The  Modocs,  who  as  yet  have  assumed  but  few  of  the 
customs  of  civilized  life,  are  always  delivered  in  this  posi- 
tion ;  their  method  is  as  peculiar  as  it  is  instructive,  and  is 
worthy  our  most  careful  consideration  ;  they  maintain  a 
curved  position,  lying  on  the  side,  until  the  labor  is  nearly 
completed,  when  they  assume  the  position  on  their  knees 
and   hands,  which  is  continued   until  the  child  is  born.^ 


Fig.   19. —  Kootenai  Squaw.     Knee-face  position,  with  assistant  astraddle. 

Experience  has  evidently  taught  them  that  these  different 
positions  assumed  during  various  stages  of  labor  would 
make  it  progress  most  rapidly,  with  least  pain  to  them-' 
selves. 

In  ordinary  cases  the  Creeks  assume  what  we  might  call 
an  overdone  knee-chest  position  ;  they  are  delivered  lying 
on  face  and  chest,  and  hence  I  have  classed  them  as  hori- 
zontally recumbent. 

*  E.  L.  Moro^an,  M.  D. 

^  F.  A.  Bickford,  M.  D.,  Quapaw  Agency. 


POSTURE.  93 

The  natives  of  the  Micronesian  ^  and  surrounding  islands, 
like  the  Modocs,  are  delivered  upon  their  hands  and  knees, 
sometimes  in  a  recumbent  position ;  certain  of  their  old 
women  act  as  midwives. 

They  roll  about  as  they  please  until  the  very  last  stage, 
the  expulsion  of  the  child,  when  they  take  this  position,  upon 
the  hands  and  knees,  and  retain  it  usually  until  the  placenta 
is  expelled.  They  have  no  peculiar  ceremonies,  but  apply  to 
their  ghost  workers  for  intercession  in  their  behalf  in  case  of 
difBcult  labor  or  sickness.  Massage  and  expression  are  used, 
especially  for  the  expulsion  of  the  placenta  and  after  labor, 
to  hasten  the  contractions  of  the  womb,  when  the  woman 
lies  upon  her  back  and  her  belly  is  kneaded.  Difficult  labor 
occurs  seldom  ;  and  during  thirty  years'  residence  among  the 
natives  on  the  Micronesian  Islands  Mr.  Sturgis,  my  inform- 
ant, has  never  known  of  a  single  case  of  death  of  the  mother 
in  labor. 

(b^.)     Inverse  Knee-Elbow  Position. 

This  peculiar,  and  apparently  strained,  position  has,  like 
the  knee-elbow  position  itself,  been  recommended  for  the 
relief  of  fat  women  in  labor,  more  particularly  by  early 
Italian  and  German  authorities.  Thus  Melli,^  who  however 
credits  it  to  Mercurio,^  "  e  prima  di  lui  gli  antichi  maestri." 
The  advantages  assigned  for  this  rather  difficult  position  are, 
that  the  pressure  of  intestines  and  fat  is  thus  removed  ;  but 
as  by  the  kindness  of  Drs.  Fletcher  and  Yarrow,  of  the  Sur- 
geon General's  Library  in  Washington,  photographs  of  the 
original  illustrations  have  been  furnished  me,  they  will  be 
best  explained  in  the  words  of  Melli,  p.  288,  as  follows : 

"  How  a  pregnant  woman,  who  is  very  fat  and  corpulent, 
is  to  be  placed  and  managed  during  labor. 

"  Difficult  labor,  caused  by  excessive  corpulency,  may  be 
facilitated  not  only  by  the  ordinary  remedies  prescribed  be- 

iRev.  Dr.  A.  A.  Sturgis,  missionary  to  the  Micronesian  Islands. 

2  Sebastiano  Melli,  La  Comare  levatriche  istruita  nil  suo  ufflzio,  etc. 
Venezia,  1776.     4^. 

"Scipio  Mercuric,  La  Comare,  Kiuclerrautter  oder  Hebammen-Buch,, 
Wittenberg,  4''.  1671;  p.  428.) 


94 


LABOR:  AN  ETHNOLOGICAL  STUDY. 


fore,  but  also  by  the  posture  and  couch  of  the  parturient 
woman,  as  Avicena  has  described  this  posture,  and  which  is 
indeed  so  well,  convenient  and  useful  to  promote  cases  of 
difficult  labor  that  it  ougjht  to  be  studied  by  all  midwives,  and 
be  adopted  by  them  in  case  of  necessity.  Although  an  illus- 
tration has  been  given,  it  appears  necessary  to  explain  this 
one. 


■■':f0^^^W^^^m 


Fig.  20.    Position  for  Delivery  of  very  Fat  Women.i    Melli. 

"  The  midwife  takes  two  or  three  cushions  or  bolsters, 
arranging  them  in  such  manner  that  the  back  only  of  the 
patient  is  supported  when  placed  upon  it,  so  that  the  abdo- 
men is  protruding  and  the  head  hanging  downwards  to  the 
floor.  The  patient  being  placed  upon  the  bolsters  firmly, 
she  will  bend  her  feet  inwards  towards  the  pelvis,  a  posture 
which  tends  to  widen  the  vagina,  and  rendering  it  possible 
that  women,  however  fat,  may  be  delivered  with  ease,  be- 
cause the  corpulency  of  the  abdomen  is  in  this  posture  ex- 
panded and  pressed  sidewards,  and  therefore  does  not  inter- 
fere with  the  child  being  born  in  the  usual  way. 

1  This  illustration  is  taken  from  Melli,  as  the  cut  is  much  more  care- 
fully finished  than  in  Mercurio,  who  entitles  this  plate  :  "  A  sito,  nel- 
(lualo  si  debbono  collocare  le  donne  parturiente,  che  sono  molto 
grasse." 


POSTURE. 


95 


"  This  posture  and  support  is  much  more  convenient,  and 
better  in  such  a  case  than  the  best  obstetric  chair ;  for  when  a 
parturient  patient  is  sitting  in  an  obstetric  chair,  her  abdo- 
men, corpulency  and  intestines  press  upon  the  womb  and 
and  foetus,  preventing  its  delivery  and  exit." 


Fig.  21.    Delivery  of  a  fat  woman  in  Medieval  Italy. 

The  patient  rests  upon  her  knees  and  shoulders,  sometimes 
the  small  of  the  back  being  supported  by  a  large  number  of 
cushions,  as  the  belly  is  raised  high  up  by  the  approach  of  the 
knees  and  shoulders.  This  position  is  assumed  in  different 
ways:  upon  the  bed,  upon  the  ground,  or  by  the  patient 
simply  lying  flat  crosswise  upon  the  bed,  her  nates  at  its  edge 
and  her  feet  upon  the  ground.     I  am  very  much  inclined  to 


96 


LABOR:  AN  ETHNOLOGICAL  STUDY. 


think  that  the  knee-elbow  position  recommended  by  ancient, 
especially  Italian,  writers  for  the  delivery  of  fat  women,  was 
not  what  we  call  the  knee-elbow  position,  but  this  peculiar 
posture  since  ignored. 


Fig.  22.    Modification  of  the  position  for  fat  women. 

The  above  figure  represents  the  same  position  as  a  very 
corpulent  lady,  not  in  active'gymnastic  practice,  might  reason- 
ably be  supposed  to  assume  it,  and  even  this  is  trying  if  re- 
tained for  any  length  of  time. 

The  midwife  seems  to  be  engaged  in  a  favorite  act,  as  her 
hands  are  employed  precisely  as  shown  in  Fig.  24 — introduced 
as  a  wedge-shaped  dilator  into  the  vagina  to  distend  the  soft 
parts — an  often  injurious  interference  to  which  her  sisters  of 
to-day  are  still  much  given ;  she  has  however  well  arranged 
the  patient's  garments,  so  as  to  preserve  them  from  contact 
with  the  escaping  fluids,  and  prevent  the  necessity  of  an  im- 
mediate change. 


POSTURE. 


97 


{c.^  Kneeling,  ivitJi  the  body  erect,  inclined  backward, 
or  partially  suspended. 

This,  like  other  of  those  apparently  peculiar  positions 
which  are  fast  yielding  to  the  westward  march  of  civiliza- 
tion and  scientific  medicine,  was  at  one  time  not  unusual  in 
our  States,  and  I  will  cite  the  early  experience  of  Dr. 
Reamy  in  Ohio  as  characteristic  of  the  practice  thirty 
years  ago ;  he  says  :  "  I  have  found  in  my  practice  ten  or 
twelve  different  women,  who  had  frequently  borne  children 
before,  who  insisted,  with  a  perseverance  and  determina- 
tion that  I  dared  not  resist,  in  being  out  upon  the  floor, 
down  upon  their  knees,  leaning  backward  so  that  the  but- 
tocks almost  touched  the  heels.  The  husband  knelt  be- 
hind the  wife,  with  his  arms  around  her,  his  broad  strong 
hands  acting  as  a  pad  for  the  abdomen,  and  making  pres- 
sure during  pains  —  a  la  Crede  —  her  shoulders  resting 
against  the  man's  chest.  These  women  insisted  that  this 
was  the  only  position  in  which  they  could  be  comfortably 
and  successfully  delivered."  The  same  position,  practically, 
is  found  among  the  Papagos.  Among  these  Indians,  "  the 
position  of  the  squaw,  from  the  time  the  labor  pains  com- 
mence until  the  expulsion  of  the  fetus  and  placenta,  is  a 
kneeling  one,  with  the  knees  sufficiently  spread  to  furnish 
comfortable  lateral  support  to  the  body,  which  is  erect.  In 
the  interval  between  the  pains  she  is  allowed  to  move  about 
according  to  her  inclination.  In  ordinary  labors  two  women 
assist  her.  One  of  them  places  herself  in  a  kneeling  posi- 
tion behind  the  parturient  woman,  and  with  one  knee  press- 
ing firmly  in  the  lumbar  region,  she  grasps  with  both 
hands  the  body  of  the  patient  immediately  under  the  ribs 
in  front.  The  other  assistant  places  herself  in  a  kneeling 
position  in  front  of  the  woman,  and  with  the  palms  of  both 
hands  rubs  the  abdominal  wall  down  from  the  spine  of  the 
ilium  to  the  pubes.  It  is  interesting  to  note  that  they  seem 
to  appreciate  the  necessity  and  advisability  of  time  and  pa- 
tience with  primiparae,  as  they  do  not  resort  to  the  same 
degree  of  pressure  and  friction  which  they  employ  in  as- 
sisting multiparae.^ 

1  J.  O.  Skinner,  M.  D.,  Surgeon  U.  S.  A.,  Fort  Lowell,  A.  T. 


98  LAB  OR:   AN  E  THNOL  O  GTCAL  S  TUD  T. 

The  Yuma  Indians  vary  this  position  somewhat.^  The 
parturient  woman  is  assisted  by  two  others  of  long  experi- 
ence in  the  business.  One  of  these  kneels  behind  her,  sup- 
porting her  body  in  nearly  an  upright  position,  her  arms 
passing  under  those  of  the  patient  and  pressing  or  smooth- 
ing down  the  abdomen.  The  other  assistant  squats  in 
front,  between  the  feet  of  the  patient,  with  her  ankles 
crossed,  and  her  shins  pressed  against  those  of  the  partu- 
rient woman,  whilst  she  holds  her  by  the  hands  or  wrists. 
The  posture  of  the  patient  is,  therefore,  with  the  shoulders 
high,  the  legs  and  thighs  strongly  flexed  and  abducted,  which 
position  is  retained  until  the  expulsion  of  the  placenta.  No 
bandage  is  used. 

The  Upper  Klamath  and  nearly  related  Modocs  of  Ore- 
gon are  usually  delivered  in  a  small  lodge  some  distance 
away  from  the  other  houses.  The  parturient  also  assumes 
a  kneeling  position,  supported  by  one  old  squaw,  whilst 
another  keeps  kneading  and  rubbing  her  abdomen.  Some- 
times she  varies  her  posture  by  sitting  and  pressing  her 
feet  against  some  support,  while  she  bears  down.  If  labor 
is  tedious,  they  often  sit  over  warm  stones  moistened  with 
water,  or,  in  other  words,  take  a  steam  bath  to  relax  the 
system.  They  also  steam  themselves  occasionally  for  sev- 
eral days  after  the  birth  of  the  child. ^ 

Precisely  this  same  position  is  found  among  many  of  the 
Mongolians,  especially  the  Tartars,  if  we  may  accept  the 
authority  of  Hureau  de  Villeneuve.^  The  parturient  moves 
about  during  the  early  pains,  sometimes  standing  with  her 
hands  above  her  head,  but  as  soon  as  the  bearing-down 
pains  begin  she  assumes  the  kneeling  position  last  de- 
scribed, almost  erect,  supporting  her  body  upon  the  hands, 
which  rest  upon  the  separated  knees  or  thighs  ;  the  assist- 
ant behind  supports  her  by  seizing  her  under  the  arms, 
whilst  the  midwife  rests  upon  one  knee  in  front  of  the  pa- 

^  Surgeon  J.  K.  Carson,  U.  S.  A. 
2  James  S.  Dennison,  M.  D. 

8  De  r aocouchement  dans  la  race  j'autie,  Paris,  1863,  p.  32 ;  Ploss- 
p.  40. 


POSTURE.  99 

tient.  The  author  seems  to  think  that  the  advantages  of 
this  position  are  greater  than  its  disadvantages,  that  the 
abdominal  muscles  come  more  freely  into  play,  and  that 
there  is  less  danger  of  rupture  of  the  perineum,  as  the  head 
of  the  child,  following  the  pelvic  axis,  tends  by  its  own 
weight  towards  the  vaginal  orifice,  and  not  towards  the  peri- 
neum, which  in  this  way  escapes  the  pressure  necessarily 
bearing  upon  it  in  any  other  position.  Prolapse  is  not 
known  among  them.  While  writing  this  my  attention  is 
called  to  a  circular  just  received,  giving  the  titles  of  papers 
entered  to  be  read  before  the  subsection  of  Anthropol- 
ogy, at  the  coming  meeting  of  the  American  Association 
for  the  Advancement  of  Sciences,  to  be  held  in  Boston, 
August,  1880.  I  find  that  a  paper  is  announced  entitled, 
"  Parturition  :  Kneeling  Posture  as  practiced  by  the  Women 
of  the  Mound  Builders  and  Stone  Grave  Races,"  by  Rev. 
C.  Foster  Wilhams  of  Ashwood,  Maury  Co.,  Tenn.  In 
answer  to  an  inquiry,  Mr.  Williams  states  that  he  has 
in  his  collection  of  Mound  Builder  relics  an  earthen  vessel, 
which  he  supposes  to  represent  a  woman  in  labor :  the 
right  knee  on  the  ground,  with  the  right  hand  resting  on 
that  knee;  the  left  foot  on  the  ground,  the  left  hand  resting 
on  the  left  knee.-'  Although  sorry  to  disabuse  Mr.  Williams 
of  his  belief,  I  must  state  that  this  position  cannot  possibly 
be  assumed  by  a  parturient  woman,  as  the  muscles  would 
not  be  relaxed,  and  proper  space  would  not  be  given  for  the 
passage  of  the  child. 

My  attention  once  called  to  the  subject,  I  examined  my 
own  collection,  and  found  in  it  two  images  representing  a 
woman  in  the  erect  kneeling  posture,  the  knees  somewhat 
separated,  the  hands  resting  upon  the  knees  or  thighs  in 
precisely  the  same  position  as  that  assumed  by  the  Mon- 
golians, and  probably  the  Yumas.  It  is  not  unlikely  that 
these  figures  represent  parturient  women,  and  it  is  highly 
probable  that  the  mythical  Mound  Builders,  be  they  prede 
cessors  of  our  Indians,  or  older  tribes  of  the  same  stock, 

^  This  position  is  advocated  by  Herr  V.  Ludwig  as  the  most  favor- 
able one  for  the  first  stage  of  labor. 


100 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


were  delivered  of  their  young  in  the  same  position  as  the 
red  squaws  of  the  present  day.  Hence  we  may  take  the 
testimony  of  these  vessels,  relics  of  a  former  civilization, 
that  the  position  assumed  by  the  Mound  Builder  race  in 
parturition  was  the  erect  kneeling  one. 

The  kneeling,  partially  siispeiided,  position  is  found  among 
the  Indians  and  lower  classes  of  Mexicans  in  the  neighbor- 
hood of  San  Luis  Potosi.  The  labor  is  conducted  in  the 
following  way  :   a  round  stick  of  pine  wood,  eighteen  or 


Fig.  23.  —  Images  from  the  Period  of  the  Mound  Builders      From  the  Burial  Mounds  o1 

Missouri. 

twenty  feet  long,  and  half  a  foot  in  diameter,  is  placed 
against  the  head  of  the  bed  or  the  wall,  its  other  end  rest- 
ing upon  the  floor  at, an  angle  of  about  forty-five  degrees; 
to  this  beam  a  cord  is  tied,  knotted  at  one  end,  and  cov- 
ered with  soft  cloths.  The  parturient  woman  kneels  upon 
a  sheep-skin  spread  upon  the  floor,  seizes  the  knotted  end 
of  the  cord  in  her  hands,  and  is  delivered  in  a  kneeling, 
semi-suspended  position,  by  the  partera  or  midwife.-^  Dr. 
Barroeta  says  also  that  prolapse  and  displacement  of  the 
uterus  are  not  uncommon,  and  does  not  know  why  they  are 
1  Dr,  G.  Barroeta. 


POSTURE. 


101 


not  still  more  frequent.  From  other  sources  I  also  hear 
that  the  lower  orders  of  Spanish  women  nearly  always  take 
the  kneeling  position,  and,  as  Dr.  Coates  writes  me  from 
Pueblo,  Col.,  "  if  the  placenta  is  tardy  they  always  drink  a 
cupful  of  soapsuds,  which  produces  vomiting,  followed  by 
the  immediate  expulsion  of  the  afterbirth." 

The  lower  classes  of  Northern  Mexico  speak  the  Span- 
ish language  and  profess  the  Catholic  faith,  but  in  all  other 
respects  are  Indians,  and  retain  many  Aztec  customs  ;  so 


Fig    24. —  Northern  Mexico. 


the  accouchement,  which  is  described  to  me  by  Surgeon 
George  W.  Adair,  U.  S.  A.,  precisely  as  we  have  seen  it 
among  the  Indians  near  San  Luis  Potosi,  the  patient  kneel- 
ing, grasping  a  rope  pendent  from  the  ceiling,  and  assisted 
by  tendera  and  partem,  "  the  tendera  fixing  the  knees,  and 
holding  the  upper  portion  of  the  trunk,  as  in  a  vice,  pulls 
the  pelvis  forward,  hinged  as  it  is  upon  the  acetabulum, 
and  thus  overcomes  the  dip  of  the  plane  of  the  superior 
strait,  and  straightens  the  passage  with  greater  efficacy  and 
certainty." 


102 


LABOR:  AN  ETHNOLOGICAL  STUDT. 


The  American  Indians  on  the  frontier  of  Mexico  follow 
the  same  traditional  method  of  delivery,  hanging  on  a  rope 
suspended  from  a  rafter,  with  the  knees  bent  and  just  off 
the  ground.  The  rope,  which  is  wrapped  with  cloths  or 
towels  so  as  to  make  it  softer,  usually  hangs  at  the  edge  of 
the  bed,  so  that  the  patient  can  stand  on  her  feet  or  sit  or 


Fig.  25.  —  Coyotero  Apaches.     Difficult  Labor. 

recline  on  the  bed  during  the  intervals  between  the  pains. 
The  partera  introduces  her  hand  and  presses  on  the  peri- 
neum, not  making  a  steady  pressure,  but  during  the  entire 
time  of  the  pain  she  jolts  the  patient  up  and  down,  imagin- 
ing that  she  is  shaking  the  child  out.^ 

The  Coyotero  Apaches  place  the  parturient  in  a  similar 
position,  suspending  her  a  good  deal  more,  in  difficult  cases 
1  C.  M.  Harrison,  M.  D. 


POSTURE.  103 

if  she  does  not  succeed  in  expelling  the  child  in  the  squat- 
ting posture  customary  among  them.  **  A  rope  or  lariat  is 
tied  around  the  woman's  chest  just  beneath  her  arms,  and 
the  other  end  thrown  over  a  stout  limb  of  an  adjacent  tree, 
while  two  or  three  squaws  draw  upon  this  until  the  woman's 
knees  barely  touch  the  ground  ;  others,  generally  two,  en- 
circle the  body  with  their  arms,  and  'strip'  down  with  con- 
siderable force,  a  kind  of  '  all  pull  together,'  as  it  were. 
This  energetic  manoeuvre  generally  suffices  for  prompt  ute- 
rine work."  ^ 

The  Santee  Indians  are  almost  invariably  delivered  in  a 
kneeling  posture  on  the  floor,  with  a  bench  or  chair  in 
front  of  them  upon  which  they  rest  their  arms,  while  some- 
times they  have  a  rope  attached  above  by  which  they  par- 
tially suspend  themselves,  just  as  the  Mexican  Indians  and 
half-breeds  do.^ 

(^.)  Kneeling  Postures,  zvJiere  Precise  Description  is  Lc^cking. 

Unfortunately,  Dr.  Ploss,  in  his  valuable  and  interesting 
work,  has  failed  to  define  precisely  the  positions  assumed, 
and,  as  I  have  been  unable  to  refer  to  the  authorities  my- 
self, I  will  take  the  liberty  of  stating  in  a  general  way,  upon 
the  authority  of  Dr.  Ploss,  that  the  kneeling  posture  is  as- 
sumed occasionally,  at  least,  by  women  in  labor  in  Nica- 
ragua,3  in  Finland,*^  in  modern  Greece,^  in  Kamtschatka, 
in  eastern  Asia ;  and,  if  we  go  back  to  the  Middle  Ages, 
among  the  Abyssinians,^  a  people  who  originally  came  from 
Asia,  where,  as  we  have  already  said,  among  the  yellow 
races  the  kneeling  posture  is  a  common  one  ;  also,  under 
certain  circumstances,  in  Rome  ;  among  the  Arabs  and 
Germans  in  the  Middle  Ages.  Finally,  in  ancient  times, 
among  the  Pelasgians,  if  some  Greek  authors  are  correctly 
translated. 

If  I  may  be  permitted  to  refer  to  the  somewhat  vague 

1  Walter  Reed,  M.  D.,  Surgeon  U.  S.  A. 

2  Dr.  George  W.  Ira. 

8  W.  Marr,  Reise  7iach  Central  Amerika,  Hamburg,  1863,  vol.  i.,  p. 
275. 
*  HoUt.  6  Prof.  George.  «  J.  Ludolf,  1681. 


104  LABOR:   AN  ETHNOLOGICAL  STUDY. 

Statements  in  the  Bible,  we  find  in  i  Samuel,  iv.  19,  "  Phin- 
eas'  wife  bowed  herself  and  travailed,  for  her  pains  came 
upon  her."  This  passage,  I  am  informed,  is  commonly 
rendered  by  learned  commentators  as  kneeling ;  Gesenius, 
in  his  Hebrew  Lexicon,  so  understands  the  word.  In  Job, 
iii.  12,  "Why  did  the  knees  prevent  me,"  the  Latin  word 
being  prevenio,  to  go  before  ;  as  if  Job  had  said,  "  Why 
did  not  the  knees  of  my  mother  remain  rigid  and  stiff,  and 
I  strangle  in  birth."  The  whole  passage  sustains  this  idea 
of  kneeling.^ 

4.    SEMI-RECUMBENT. 

The  semi-recumbent  positions  are  by  far  the  most  fre- 
quent among  the  ancients,  especially  among  the  more  civ- 
ilized people  of  olden  times,  and  among  the  savage  races 
of  the  present  day.  The  same  position  of  the  body  is  as- 
sumed by  various  races  in  very  different  ways,  there  being 
apparently  no  resemblance  in  the  method  of  delivery,  whilst 
it  appears,  upon  more  careful  study,  that  the  position  of  the 
body,  the  inclination  of  the  trunk  and  the  pelvic  axis,  to- 
gether with  the  relaxed  position  of  the  thighs,  is  almost 
identical,  the  same  end  being  accomplished  in  ways  very 
different,  peculiar  to  each  people,  and  in  keeping  with  their 
surroundings.  Thus,  the  simplest  of  the  semi-recumbent 
positions,  which  is  upon  a  par  with  the  customs  of  the  rudest 
African  races,  is  sitting  upon  the  ground,  upon  a  stone  or 
rude  cushion,  with  the  body  inclined  backward,  leaning 
against  an  assistant,  a  tree,  or  some  other  object.  A  marked 
progress  is  achieved,  when  we  find  the  parturient  woman 
seated  in  the  lap  of  an  assistant  reclining  against  his  chest, 
a  position  which  reaches  its  greatest  perfection  in  the  ob- 
stetric chair.  As  the  next  step,  I  regard  the  dorsal  decu- 
bitus, a  position  modified  according  to  the  circumstances 
of  the  people.  In  the  wilds  of  Africa,  and  in  the  interior 
of  our  western  country,  the  patient  finds  her  couch  upon 
the  floor,  propped  up  against  some  staves  of  wood  or  a  pile 
of  grass,  whilst  in  the  lying-in  chamber  of  the  civilized  peo- 
^  C.  Foster  Williams. 


POSTURE.  105 

pie  we  find  the  same  position  assumed  upon  the  bed,  and 
this  I  look  upon  as  the  perfection  of  obstetric  positions,  the 
easiest,  most  comfortable,  and  advantageous. 

{a)  Sitting  Semi-recumbejit  on  the  Grojind,  upon  a  St  one ^ 
or  Stool. 

Among  our  Indians  we  find  that  the  Otoes,  Missouris, 
Omahas,  lowas,  and  nearly  related  tribes  assume  the  sitting 
posture,  the  legs  widely  separated  ;  but  as  the  crisis  super- 
venes, the  patient  raises  herself  somewhat  by  a  rope  sus- 
pended above,  thus  attaining  an  inclined,  semi-recumbent 
position.^  The  Wakah  squaw  assumes  a  sitting  posture,  on 
the  floor  of  the  lodge,  with  nothing  but  an  Indian  mat 
under  her.  As  soon  as  the  labor  pains  come  on  her  feet 
are  drawn  up  close  to  the  buttocks,  and  the  legs  flexed ; 
this  position  is  maintained  until  after  the  birth  of  the  child 
and  the  expulsion  of  the  placenta.^ 

The  women  of  the  Skokomish  Agency,  W.  T.,  sit  down 
with  a  pillow  or  roll  of  blankets  resting  against  the  peri- 
neum ;  one  squaw  supports  the  back,  while  another  receives 
the  child.  This  position  is  a  slightly  recumbent  one,  the 
buttocks  resting  on  the  pillow  or  roll  of  blankets.^  The 
Confederated  tribes  of  the  Flatheads,  Pend  d'Oreilles,  and 
Kootenais,  follow  a  similar  custom  :  a  small  box,  or  a  piece 
of  wood,  six  or  eight  inches  high,  covered  with  old  pieces  of 
blanket  or  buffalo  robes,  is  the  seat  upon  which  the  sick 
woman  is  placed  ;  her  legs  are  separated  and  flexed  so  that 
the  heels  almost  come  in  contact  with  the  seat.  She  is  re- 
tained in  that  position  by  two  assistants  who  hold  her  by 
the  arms,  and  sometimes  a  third  one  stands  behind  and 
presses  upon  her  shoulders,  and  in  this  position  the  child 
is  expelled.* 

Though  apparently  uncomfortable  and  inconvenient,  and 
rare  among  the  the  American  Indians,  the  Kaffirs  univer- 

^  Dr.  W.  C.  Botener,  Oloe  Agency,  Nebraska. 
2  J.  N.  Powers,  M.  D.,  Neah  Bay  Agency,  W.  T. 
8  J-  W.  Givens,  M.  D. 
*  L.  H.  Choquette,  iM.  D. 


106 


LABOR:  AN  ETHNOLOGICAL  STUDY. 


sally  adopt  this  obstetric  position,  sitting  with  the  heels 
drawn  up  to  the  buttocks,  the  shoulders  generally  resting 
against  one  of  the  poles  supporting  the  roof  of  the  hut,  or 
against  some  one  of  the  female  friends,  who  are  present  in 
full  force. 


Fig.  26.  — Kaffir  Woman  in  Labor. 


A  somewhat  similar  position  in  labor  seems  to  be  fol- 
lowed in  Germany  by  Russian  emigrants  who  came  there 
in  1858  (Prussian  Pomerania).  They,  however,  do  not  raise 
the  shoulders  so  much.  Dr.  C.  J.  Egan,  who  makes  this 
statement,^  adds:  "The  Kaffir  position  is  a  very  good  one, 
and  the  woman  has  full  power  to  bear  down  and  assist  her 
pains.  Of  course,  in  this  position,  no  support  can  be  given 
to  the  perineum  by  the  hand  of  the  attendant,  but  I  am 
much  inclined  to  think  that  some  very  useful  support  is 
*  Midwifery  Notes  frotn  British  Kaffraria,  in  South  Africa, 


POSTURE.  107 

given  the  perineum  trom  its  resting  on  t'he  firm  floor  of  the 
hut,  and  the  sudden  passage  of  the  child's  head  is  thereby 
prevented." 

The  Kaffir  and  the  Indian  woman  sit  upon  the  ground, 
whilst  the  somewhat  more  advanced  half-breed,  as  she  is 
often  found  in  Southern  California  and  New  Mexico,  seats 
herself  upon  a  chair,  and  during  the  pains,  in  the  same 
way  as  her  Indian  sister,  grasps  a  rope  suspended  from 
the  ceiling  above  ;  but,  when  tired  out  in  this  position, 
she  is  often  found  kneeling  upon  the  ground. ^  A  white 
sister  involuntarily  testifies  to  the  efficiency  of  this  po- 
sition, at  least  under  certain  conditions,  —  a  primipara 
who  had  been  in  labor  for  two  days  and  was  confined  on 
the  third,  in  a  sitting  posture,  the  pains  ceasing  entirely 
whenever  she  assumed  a  recumbent  position  ;  of  this  the 
observing  attendant,  Dr.  Von  Mansfelde,  of  Ashland,  Neb., 
assured  himself.  In  order  to  satisfy  himself  that  it  was 
not  the  whim  of  a  parturient  woman,  he  placed  her  on  the 
bed,  on  her  side  and  back,  several  times,  but  the  hand 
placed  upon  the  fundus  showed  complete  relaxation ;  no 
sign  of  contraction.  When  replaced  in  the  sitting  pos- 
ture the  pains  readily  returned,  and  were  very  effective,  the 
woman  being  delivered  within  two  hours  after  dilatation  of 
the  OS. 

The  Arab  woman  is  seated  on  two  flat  stones,  or,  more 
properly,  her  buttocks  are  slightly  supported  upon  two  flat 
stones,  whilst  during  each  pain  she  partially  raises  herself 
by  a  rope  which  is  suspended  from  the  centre-pole  of  the 
tent.  Two  assistants  seize  the  parturient  woman  under  the 
shoulders,  and  she  herself,  during  the  pain,  raises  herself  by 
the  rope  ;  they  aid  this  motion,  partially  suspend  her,  shak- 
ing her  well,  as  the  miller  does  his  sack  of  flour  when  he 
empties  it,  and  then,  as  the  pains  cease,  they  drop  her  back 
upon  the  stones.  This,  at  least,  was  the  practice  witnessed 
in  several  cases  in  1858  by  Dr.  Goguel,^  in  one  instance, 

^  King,  Afu.J.  Sc,  April,  1853,  jj.  891. 

2  "  Accouchement  chez  les  Hebreux  et  les  Arabes,"  Gaz.  hebd.  de 
mid..  No.  23. 


.108  LABOR:   AN  ETHNOLOGICAL  STUDY. 


Fig.  27.  —  Oronoko  Indian.     Seated  semi-recumbent  in  hammock 


POSTURE.  ]^Q9 

the  patient  being  the  wife  of  a  sheik.  In  Massana,  upon 
the  Red  Sea,  the  woman  of  the  lower  classes  sits,  in  the 
same  way,  upon  a  flat  stone,  reclining  against  some  con- 
venient support,  or  held  in  the  arms  of  a  friend.  The  na- 
tives of  the  Antilles  not  unfrequently  assume  a  sitting, 
semi-recumbent  position.  In  some  portions  of  South  Amer- 
ica, where  hammocks  serve  so  many  purposes,  for  instance, 
among  the  Indians  of  the  Oronoko  and  Guiana,  the  partu- 
rient woman  is  delivered  while  seated  upon  the  hammock, 
which  is  rolled  almost  into  a  rope.  The  assistant  stands 
behind  to  support  the  patient,  whilst  the  midwife,  often  a 
very  skillful  woman,  is  seated  in  front,  and  remains  to  fulfill 
her  office.^ 

A  most  admirable  position,  typically  semi-recumbent,  was 
customary  in  Greece  and  her  provinces  2,200  years  ago,  as 
is  proven  by  that  interesting 'group,  representing  a  labor 
just  completed,  which  was  discovered  by  General  di  Ces- 
nola  during  his  researches  in  Cyprus  ;  we,  moreover,  have 
the  same  undeniable  evidence  that  this  marble  group  faith- 
fully represents  the  obstetric  position  in  Cyprus  twenty-two 
centuries  ago  as  we  have  of  the  correctness  of  the  Peruvian 
posture  at  the  time  of  the  Inkas,  as  pictured  upon  the 
funeral  urn.  The  native  Peruvians  of  the  present  day  are 
still  confined  whilst  seated  upon  the  husband's  lap  ;  and 
the  Cypriote  midwife  of  to-day  still  places  her  patient  in 
the  semi-recumbent  position  upon  a  low  stool  which  she 
carries  about  with  her. 

In  response  to  my  inquiries.  General  di  Cesnola  kindly 
furnished  me  with  the  following  most  valuable  information. 
He  says  :  "  The  group  was  found  among  the  debris  of  the 
temple  at  Golgoi,  in  1871,  and  is  of  the  best  Greek  epoch,. 
say  400  B.  c.  The  chair  on  which  the  woman  is  reclining,. 
is  Cypriote,  and  was  probably  used  also  in  Greece  at  that 
period  ;  the  modern  Cypriote  midwives  possess  similar  low 
chairs,  which  they  carry  with  them  when  going  to  attend  a 
child-birth,  and  I  have  myself  seen  the  circumstances  as 
shown  in  that  group,  which  faithfully  represents  the  partu- 
■^  Dr.  Georo^e  W.  Barr. 


110 


LABOR-   AN  ETHNOLOGICAL  STUDY. 


rition  scene  of  to-day.  An  assistant  of  the  midwife's  is 
kneeling  behind  the  patient,  holding  her  head  upon  her 
shoulder  ;  the  midwife,  who  is  seated  upon  a  very  low  stool 
in  front  of  the  parturient  and  between  her  separated  legs, 
has  just  extracted  the  child  which  she  has  on  her  arms. 
The  exhausted  woman,  seated  in  a  semi-recumbent  position 
on  a  low  stool,  still  has  her  legs  wide  apart,  but  has  been 
covered  with  a  blanket  and  is  left  to  rest  for  a  few  minutes 


Fig.  28. —  Labor  Scene  in  Ancient  Greece.     Group  in  the  Cesnola  Collection,  New  York 

previous  to  being   replaced   in  her  bed The  chairs 

which  I  have  seen,  and  especially  the  one  which  the  mid- 
wife of  Larnaca  brought  to  the  house  of  our  friend,  had  no 
pillows,  but  two  arms  ;  and  the  seat,  though  not  perforated, 
had  a  peculiar  shape,  with  a  ridge  in  the  centre,  evidently 
made  for  the  purpose  of  keeping  the  legs  apart  as  much  as 
possible." 

Although  Cyprus  was  held  at  various  times  by  Pheni- 
cians,  Assyrians,  Egyptians,  Persians,  and  Romans,  this 
much  mutilated  group  so  unmistakably  bears  the  imprint 


POSTURE. 


Ill 


of  Greek  art  that  we  must  look  upon  it  as  representing  the 
custom  of  those  people  and  those  of  Cyprus  during  the 
Greek  period,  and  well  representing  it,  for  the  position  of 
the  parturient  is  an  admirable  one,  unmistakably  seated, 
semi-recumbent,  upon  a  low  stool,  which  cannot  be  termed 
an  obstetric  chair,  as  is  done  in  the  description  of  the  group 
in  the  "  Transactions  of  the  Edinburgh  Obstetrical  Soci- 
ety." ^  Great  importance  is  attached  to  it  by  the  author  of 
that  paper,  as  demonstrating  the  antiquity  of  the  obstetric 
chair,  but  the  fallacy  of  this  view  is  already  well  proven  by 
the  criticism  of  Seligman  in  Virchow's  "  Jahresbericht." 


Fig.  29.  —  Modern  Cypriote  Midwife's  Chair. 

In  southern  India  the  patient  walks  about  during  the  ear- 
lier stages  of  labor,  then  sits  upon  the  ground  with  the 
thighs  well  separated,  the  back  supported  by  an  assistant, 
whilst  the  delivery  itself  is  finally  accomplished  while  lying 
upon  the  ground.^ 

{b.)   Sitting  on  the  Lap  or  between  the  Thighs  of  an  Assist- 
ant who  is  seated  on  a  Chair  or  on  the  Floor. 

I  look  upon  this  position  as  identical  with  that  on  the  ob- 
stretric  chair,  although  more  simple  and  more  ancient  ;  and 
I  believe  that  it  will  be  apparent  to  every  one,  if  the  rela- 
tive positions  are  considered,  that  the  obstetric  chair  is 
merely  an  imitation  of  the  more  pliable  and  sensitive  sup- 
port afforded  by  the  husband  or  assistant,  who  is  himself 
made  to  suffer  whilst  holding  the  parturient  woman  during 

^  1878,  vol.  iv.,  p.  50. 

»  Shortt,  Edinb.  M.J.,  Dec,  1864,  p.  554. 


112  LABOR:   AN  ETHNOLOGICAL  STUDY. 

the  tedious  hours  of  labor.  I  am  heartily  in  accord  with 
the  statement  of  Rigby,  although  seriously  questioned  by 
Ploss,  that,  "as  far  as  we  may  rely  upon  the  meagre  records 
which  history  gives  us  upon  this  subject,  among  the  more 
civilized  people  of  antiquity  the  semi-recumbent  sitting  pos- 
ture was  by  far  the  most  common.  In  proof  of  this  I  will 
again  refer  to  the  oft-mentioned  funeral  urn  which  so  vividly 
pictures  the  position  of  patient,  husband,  and  nurse  in  the 
lying-in  chamber  during  the  moment  of  the  greatest  trial, 
during  the  expulsion  of  the  child.  The  patient  is  seated  in 
the  lap  of  an  assistant.  I  can  hardly  say  whether  this  is 
the  husband  or  a  female  assistant,  whether  it  is  a  male  or 
'female  figure ;  at  all  events  she  is  seated  in  the  lap  of  a  per- 
son whose  arms  encircle  her  waist,  the  hands  pressing  firmly 
upon  the  fundus  of  the  uterus.  The  midwife  is  seated  upon 
a  low  stool,  between  the  separated  legs  of  the  patient,  and  is 
just  in  the  act  of  receiving  the  head  of  the  new-born  child. 
This  vessel,  called  Huaco,  represents  a  parturient  scene  pre- 
cisely as  it  is  still  enacted  among  the  descendants  of  the 
Incas  to  this  day,  and  Dr.  Coates  assures  me  that  he  has, 
during  his  stay  in  Peru,  not  unfrequently  acted  accoucheur, 
the  woman  always  taking  this  position  with  the  husband 
behind.  Upon  that  entire  coast  of  South  America  the  in- 
habitants seem'  faithfully  to  adhere  to  the  customs  of  their 
ancestors,  and  no  better  proof  can  be  found  of  the  correct- 
ness of  the  representation  of  the  labor  scene  depicted  upon 
this  vessel  than  the  above  statement  of  Dr.  Coates,  and  of 
other  physicians,  the  most  interesting  of  which  is  perhaps 
one  by  Dr.  Ruschenberger,^  who,  whilst  in  Colina,  in  Chili, 
in  1823,  was  called  to  a  case  of  placenta  previa  and  found 
a  lady,  a  lady  of  rank  by  the  way,  with  her  feet  near  the 
foot  of  the  bed,  the  knees  drawn  up,  reclining  against  her 
husband,  a  rather  short  corpulent  man,  who  was  sitting  in 
the  middle  of  the  bed  wearing  his  riding  cap,  booted  and 
spurred,  with  the  legs  extended  on  each  side  of  her  and  his 
hands  clasped  in  front  of  her  chest  to  afford  support.  The 
antiquity  of  this  position  is  also  proven  by  a  passage  in 
1  A7n.  J.  Obst.,  Oct.,  1879,  P-  737- 


POSTURE. 


113 


Genesis  (xxx.  3),  which  says  that  the  Hebrew  women  were 
confined  upon  the  lap  of  a  female  assistant.^  In  ancient 
Rome  this  position  was  assumed  in  cases  either  of  urgent 
necessity,  or  among  the  poor  where  the  obstetric  chair  was 
not  to  be  had.  Moschion  teaches  his  readers  to  help  them- 
selves in  this  way  and  it  seems  that  these  teachings,  revived 
in  Italy  by  Joannis  Michaelis  of  Savonarola,^  finally  found 
their  way  into  Germany.     In  France,  also,  an  author  like  De 


Fig.  30.  —  The  Scientific  Posture  advocated  in  the  i6th  century. 
Savonarola,  1547. 


From  Joannis  Michaelis 


La  Motte  ^  became  a  warm  advocate  of  this  position.  Joan- 
nis Michaelis  highly  lauds  a  very  low  three-legged  stool 
which  serves  as  a  seat  for  the  assistant  in  whose  lap  the 
patient  reclines  ;  he  speaks  of  it  as  being  of  great  antiquity, 
and  much  esteemed  by  the  ancient  Greeks.  -  The  assistant 
stands  behind,  on  a  rounded  knob,  supporting  the  patient, 
who  is  seated  in  front,  upon  the  forked  portion  of  the  stool. 
At  a  comparatively  late  period  a  similar  method  of  delivery 
was  adopted  among  the  modern  Greeks."^     The  parturient 

^  Kotelmann,  Die  Geburtsh.  bet  den  alteii  Hebrcrem,  Marburg,  1876 
^  Practica  major.  Vetietiis,  1547,  p.  280. 
'  Traite\  1721,  liv.  ii.,  chap.  12. 

■*  W.  Eton,  Schilderiingeti  des  tiirkischen  Reiches  ger.,  by  Bergkt. 
Leipzig,  1S05,  page  144.    Moreau,  Natur-gesch.  des  Weibes,  ii.,  page  194. 


114  LABOR:   AN  ETHNOLOGICAL  STUDY. 

woman  being  seated  upon  a  kind  of  tripod,  behind  her  upon 
a  somewhat  higher  stool  sits  an  assistant  whose  arms  are 
clasped  over  the  fundus  of  the  womb  whilst  the  midwife  is 
seated  in  front.  I  regard  these  positions  as  in  the  lap  of  an 
assistant  and  can  certainly  not  look  upon  a  simple  stool,  as 
it  was  probably  found  in  any  kitchen  at  the  time,  as  an  ob- 
stetric chair,  but  from  that,  most  unquestionably,  the  ob- 
stetric chair  takes  its  origin,  and  a  very  pointed  statement 
to  this  effect  is  made  by  Dr.  Metzler,^  who  in  the  early  part 
of  this  century  found  an  obstetric  chair  in  some  remote  vil- 
lage where  he  little  expected  to  see  it,  which  had  been  con- 
structed by  a  carpenter  who  had  neither  seen  an  obstetric 
chair  nor  heard  of  one  ;  but  his  wife  had  found  her  labor 
so  easy,  while  sitting  upon  his  lap,  his  legs  separated,  that 
he  soon  obtained  a  reputation  in  his  native  village,  so  that 
finally  not  a  woman  in  the  place  would  be  confined  in  any 
other  way  than  upon  this  good  man's  lap  ;  this  he  soon 
found  so  irksome  that  he  constructed  this  chair,  and,  in  his 
endeavors  to  copy  the  position  assumed  by  himself,  a  very 
fair  obstetric  chair  resulted.^  The  above  also  seems  to  ver- 
ify the  statement  that  certain  persons  seem  especially  fitted, 
and  acquire  a  reputation  for  such  work ;  in  Holland  they 
were  a  regular  convenience  at  every  labor,  and  were  known 
as  "  shootsteers  ;  "  but  not  only  here  and  there  in  Germany, 
in  France  or  Holland,  but  also  among  the  early  Scotch, 
Welsh,  and  English  was  this  position  frequently  resorted  to, 
and  we  need  not  be  astonished  to  see  this  same  custom  in 
our  own  country. 

We  have  seen  how  the  modern  Peruvians  still  follow  the 
ways  of  the  Incas,  and  so  the  descendants  of  these  Ger- 
mans, Welsh,  or  Scotch  have  not  forgotten  the  habits  of 
their  ancestors,  although  they  have  crossed  the  seas  and 
have  mingled  with  a  more  enlightened  civilization.  It  may 
surprise  some  of  our  city  practitioners  of  to-day,  who  see 
little  of  the  country  population,  and  especially  those  who 
have  not  practised  in  rural  districts  years   ago,  that  in  our 

1  Jenaisches  Archiv.f.  Geburtsh. 

2  See  Fig.  30. 


POSTURE. 


115 


own  States  women  are  confined  sitting  upon  the  lap  of  the 
husband  or  an  assistant  ;  this  was,  of  course,  much  more 
frequent  thirty  years  ago  than  it  is  now,  but  I  still  hear  of  it 
in  many  of  our  States,  especially  in  southern  Ohio,  Penn- 
sylvania, southwestern  Missouri,  Georgia,  and  the  mountain 
regions  of  Virginia. 

A  graphic  description  of  obstetric  practice  in  the  rural 
districts  of  Ohio  is  given  me  by  Dr.  E.  B.  Stevens  of  Leb- 
anon, Ohio,  and  embodies  all  that  has  been  written  me  from 
other  States.  To  quote  his  own  words  :  "  When  I  com- 
menced to  practise,  a  good  many  years  ago,  the  almost  uni- 
versal habit  of  confinfement  throughout  the  regions  of  south- 


^ 
/^^^^^^g 


Fig.  31. —The  Obstetric  Couch. 

ern  Ohio  was  about  as  follows  :  two  old-fashioned,  straight- 
backed,  slip-bottom  chairs  made  the  lounge,  one  chair  erect 
the  other  turned  down ;  a  few  old  comforters  upon  this 
framework  completed  a  very  comfortable  couch  ;  the  hus- 
band took  his  seat  first,  astride,  the  wife  reclining  in  his 
arms,  where  she  remained  until  labor  was  completed,  unless 
there  was  much  delay,  in  which  case  the  patient  was  walked 
about  or  assumed  any  other  position  as  dictated  by  fancy 
or  impulse  ;  the  position  of  the  accoucheur  was  upon  an 
inverted  half-bushel  measure,  so  placed  that  he  sat  just  be- 
tween the  limbs  of  the  patient.  Labor  completed  the  soiled 
clothes  were  changed  and  the  patient  was  placed  in  bed. 


116 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


This  position  was  certainly  not  a  bad  one  for  all  parties  with 
the  exception  of  the  husband,  who,  in  tedious  cases,  suffered 
rather  severely  ;  but  then  this  little  tax  on  his  affectionate 
nature  was,  in  those  days,  considered  the  very  least  returr 
he  could  make  for  the  mischief  he  had  occasioned." 

I  have  been  told  of  this  position  in  so  many  different 
parts  of  this  country  that  it  would  be  superfluous  to  refer 
to  individual  statements  ;  it  is  found  in  Pennsylvania,  and 
among  Pennsylvania  emigrants  in  southwestern  Missouri, 


Fig.  32. —  Semi-recumbent  in  the   Husband's  Lap.     Ohio. 

the  position  being  practically  the  same,  but  differing  some- 
what in  the  details  :  thus,  three  chairs  are  placed  in  the 
form  of  a  triangle,  facing  towards  a  common  centre ;  the 
husband  takes  his  seat  in  one  of  these,  and  has  a  sheet, 
or  broad  towel,  or  any  cloth  heavy  enough,  bound  around 
his  thighs,  leaving  the  knees  about  six  inches  apart.  This 
cloth  serves  as  a  seat  for  the  parturient,  and  prevents  the 
husband's  legs  from  spreading  apart  when  tired  by  the  long 
continued  strain  ;  the  patient  puts  her  feet  on  the  rounds 


POSTURE. 


117 


of  two  other  chairs,  while  a  woman,  seated  in  each  of  them, 
takes  one  of  the  patient's  hands  and  supports  the  knee  next 
to  hers. 

A  professional  friend  in  this  State,  who,  like  many  other 
practitioners,  tells  me  that  the  first  patient  he  ever  deliv- 
ered was  confined  in  this  position,  says  that  since  then  he 
has  delivered  quite  a  number  of  women  in  this  way,  and 
thinks  it  a  great  help  in  cases  where  the  head  constantly 
retreats  after  the  pain  ceases  ;  in  the  rural  districts  of 
Georgia  both  negro  and  white  women,  now  and  then,  still 


Fig.  33.  —  Semi-recumbent  in  Lap.     Virginia. 

follow  this  custom  ;  so,  also,  in  Virginia.  A  very  minute 
description  of  such  a  labor  in  the  mountain  districts  of 
northwest  Virginia,  in  the  first  third  of  this  century,  is  given 
in  the  "  New  Orleans  Medical  and  Surgical  Journal "  for 
1860.^  It  is  not  surprising  to  see  the  white  man  thus  pa- 
tiently assisting  his  wife  in  the  hour  of  her  trial  ;  but  it 
does  seem  somewhat  strange  that  we  should  find  this  posi- 
tion, and  the  laborious  duty  imposed  by  it,  undertaken  by 
^  Dr.  Dowler,  Position  m  Parturition,  p.  490. 


118  LABOR:   AN  ETHNOLOGICAL  STUDY. 

our  red  brethren,  as  the  Indian  braves  are  usually  so  averse 
to  work  ;  but  I  must  say  that  it  is  only  now  and  then, 
among  the  Utes  and  the  Pueblos  in  Mexico,  that  this  oc- 
curs, and  they  possibly  have  copied  the  Mexicans. 

The  Indians,  and  lower  class  of  Mexicans  in  the  vicinity 
of  San  Luis  Potosi,  are  confined  either  in  a  kneeling  posi- 
tion partially  suspended,  or  sitting  upon  the  floor.  If  con- 
fined in  the  latter  position,  the  accouchee  sits  on  a  sheep- 
skin on  the  floor,  between  the  legs  of  one  of  the  assistants, 
the  teiiedora,  or  holder,  who  is  seated  on  a  little  cushion, 
and  serves  as  a  support  to  the  patient,  her  thighs  pressing 
against  the  patient's  hips,  and  her  arms  encircling  her  waist> 
the  hands  clasped  just  above  the  fundus  of  the  distended 
uterus,  so  that  she  can  follow  the  child  in  its  descent,  and 
exert  a  gradual  but  strong  compression ;  the  partera,  of 
course,  takes  her  position  in  front  of  the  patient.  Some- 
times, in  a  tedious  labor,  this  awkward  posture  is  retained 
for  one  or  two  days,  with  not  a  little  suffering  to  the  tene- 
dora  as  well  as  the  patient.^ 

The  custom  of  the  Sandwich  Islanders  varies  very  little 
from  this,  and  it  is  a  matter  of  some  interest  to  note  their 
habits,  as  these  islands,  two  thousand  miles  west  of  San 
Francisco,  were  entirely  unknown  one  hundred  years  ago, 
and  even  fifty  years  ago  were  perfectly  barbarous  ;  it  is  im- 
portant to  us,  more  especially  as  they  still  retain,  in  a  great 
measure,  their  crude  ideas  and  practices.  Very  interesting 
statements  as  to  the  obstetric  practices  in  these  islands  are 
made  by  Dr.  Charles  H.  Wetmore,"^  who  has  had  a  profes- 
sional experience  of  twenty-two  years  upon  Hawaii.  When 
the  labor  is  fairly  commencing,  the  patient  assumes  a  sit- 
ting posture  upon  a  hard  pillow  or  stone,  her  husband,  or 
some  intimate  male  or  female  friend,  kneeling  behind  her, 
whose  duty  it  is  to  clasp  her  above  the  abdomen  in  such  a 
way  that  he  can  press  down  with  considerable  force  upon 
the  uterus  and  its  contents,  never  relaxing  this  grasp  to  al- 
low the  fetus  to  recede.  The  accoucheur's  position  is  in 
front  ;  she  has  little  to  do  but  to  receive  the  child.  Pre- 
1  Dr.  G.  Barroeta.  2  Btiffalo  M.  Gr^S./.,  1872-73,  vol.  xii.,  p.  90. 


POSTURE. 


119 


cisely  the  same  custom  prevails  among  the  Andamanese, 
on  the  coast  of  India,^  the  only  difference  being  that  the 
patient  and  supporting  husband  are  seated  upon  the  ground. 
So,  also,  the  Bedouins,^  the  child,  however,  being  caught 
in  a  sieve,  which  is  held  by  an  assistant. 

I  have  repeatedly  had  occasion  to  lefer  to  the  nomadic 
and  barbarous  tribes  of  Asia,  as  they  have  so  successfully 


F:g.  34. —  Andamaaese  Labor  Scene. 

resisted  the  encroachments  and  innovations  of  civilization, 
and  among  them  many  of  these,  to  us  peculiar  positions, 
are  still  retained  by  parturient  women  ;  but,.like  the  Indian 
brave,  the  Asiatic  warrior  is  little  inclined  to  assist  his  suf- 
fering partner  ;  only  among  the  Kalmucks  is  the  parturient 
woman  delivered  in  the  lap  of  an  assistant.  The  patient  is 
seated  upon  the  knees  of  a  vigorous  young  man,  who  also 
exercises  considerable  pressure  upon  the  abdomen  by  the 
hands  which  encircle  the  woman's  waist.^     It  seems  pecul- 

^  "  Jagor  uber  die  Andamanesen  oder  Micopies,"  Zeitschr.  f.  Eth- 
nologie,  1877,  P-  51- 

-  Mayeaux,  The  Bedotihis,  chap,  iii.,  p.  176. 

•  R.  Krebel,  Volksmedic,  etc.,  p.  55;  H.  Meyerson,  Med.  Ztg.  Russ- 
lands,  i860,  xxiv.,  page  189  ;  Ploss,  36, 


120 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


iar  that  young  men  should,  among  some  people,  be  chosen 
for  this  office  ;  here  he  serves  as  an  obstetric  chair,  and 
among  the  Brule-Sioux  a  young  warrior  serves  as  a  sup- 
port for  the  parturient  squaw,  who  suspends  herself  from 
his  neck  ;  only  the  Japanese  see  that  the  physician  is  an 
aged  male,  in  case  that  these  positions  are  assumed  for  ob- 
stetric purposes. 

(c).   The  Obstetric  Chair. 

The  positions  we  have  so  far  considered  have  been  almost 


Fig.  35. — Origin  of  the  Obstetric  Chair.    (Engelmann.) 

altogether  such  as  required  no  artificial  assistance  and  were 
instinctively  assumed. 

With  the  advance  of  the  obstetric  art,  the  support  given 
the  parturient  woman  by  the  bone  and  muscle  of  her  kin, 
by  husband  or  tenedora,  was  replaced  by  a  form  of  wood ; 
the  thighs  upon  which  she  sat,  the  chest  against  which  she 
rested,  were  replaced  by  the  cut-out  seat  and  the  slanting 
back  of  the  obstetric  chair,  which  was  formed  so  as  to  re- 
ceive the  patient  in  the  same  position  which  she  was  wont 
to  occupy  on  the  lap  of  a  fellow  being. 

We  now  come  to  the  semi-recumbent  position  assumed 
by  the  parturient  woman  whose  labor  takes  places  in  the 


POSTUJRE. 


121 


obstetric  chair,  under  the  supervision  ot  a  midwife  or  phy- 
sician. 

The  obstetric  chair  marks  a  decided  era  in  the  history  of 
the  art  ;  but  I  must  consider  that  period  as  a  whole,  and  in 
speaking  of  the  chair  I  have  reference  to  its  more  charac- 
teristic features,  to  those  points  which  are  common  to  all  ob- 
stetric chairs,  as  it  is  not  my  purpose  here  to  describe  the 
various  obstetric  chairs  which  were  in  use  at  different  times, 


Fig.  36.  —  Development  of  the  Obstetric  Chair  (from  Goodell       Savonarola,  1547;    Eucharius 
Rhodius,  1544;  Deventer,  1701;  Stein,  1805. 

marking  the  progress  of  midwifery ;  the  modifications  were 
too  numerous.  "As  in  our  times,"  to  use  Dr.  Goodell's 
v^ery  striking  expression,  "  eminent  physicians  are  seeking 
to  improve  the  obstetric  forceps,  so  in  those  days  learned 
men  did  not  disdain  to  perfect  the  sella  lochcsa  obstetricia  sett 
obstetrical  My  intention  is  merely  to  refer  to  the  obstet- 
ric chair  as  being  an  artificial  means  of  placing  the  patient 
in  that  semi-recumbent  position  which  I  deem  most  advan- 


122  LABOR:   AN  ETHNOLOGICAL  STUDY. 

tageous  to  the  progress  of  labor,  and  which  uncivilized 
people  of  the  present  day,  as  well  as  civilized  nations  of 
the  past,  long  before  the  day  of  the  chair,  assumed  as  most 
comfortable  for  the  parturient  woman.  The  subject  has 
been  exhausted  by  the  able  pen  of  one  of  our  fellows,  Dr. 
Goodell,  in  his  article  on  "  Some  Ancient  Methods  of  De- 
livery;" and  Dr.  Ploss,  in  his  work,  gives  so  complete  a  his- 
tory of  this  method  of  delivery  that  I  need  but  refer  briefly 
to  the  subject.  The  obstetric  chair  which  flourished  in  the 
days  of  Greece  and  Rome  was  almost  forgotten  in  the 
darkness  of  the  earlier  centuries  of  the  Christian  era,  but 
seems  to  have  survived  in  Italy,  partly  owing  to  the  writing 
of  Greek  and  Roman  authorities,  partly  because  the  custom 
was  handed  down  from  generation  to  generation  among  the 
people  ;  and  from  Italy  it  found  its  way  across  the  Alps 
into  Germany  and  France.  By  this  time,  however,  the 
rude  stool  of  ancient  times  had  been  greatly  changed  in 
shape,  complicated  and  improved,  until  the  low  stool,  as  we 
still  see  it  in  the  hands  of  the  Cypriote  midwife,  is  presented 
to  us  as  the  typical  obstetric  chair  of  the  Middle  Ages. 

The  chair  is  mentioned  by  Albertus  Magnus  in  the  thir- 
teenth century,  and  in  the  German  translation  of  this  work, 
under  date  of  1589,  an  illustration  is  given  which  resembles 
the  obstetric  chair  of  Soranus  and  Moschion.  In  the  seven- 
teenth and  earlier  part  of  the  eighteenth  century  the  chair 
seems  to  have  flourished  in  Germany,  and  also  in  England, 
and  numerous  modifications  were  introduced.  Its  suprem- 
acy, however,  was  not  of  long  duration,  and  it  soon  yielded 
to  the  modern  recumbent  position,  and  was  only  retained 
by  the  more  conservative  people  in  the  rural  districts,  who 
'ollow  but  slowly  in  the  wake  of  any  advance.  Smellie^ 
says :  "  In  remote  parts  of  England  the  patient  sat  upon  a 
stool  made  in  the  form  of  a  semicircle."  This,  of  course, 
was  during  the  time  of  the  decline  of  the  chair,  when  the 
dorsal  and  lateral  decubitus  had  become  popular. 

In  the  seventeenth  century  it  was  to  be  found  in  the 
centres  of  medical  learning,  and  had  not  yet  been  forced 
back  into  the  rural  wilds. 

^  Vol.  i.,  p.  203,  4th  edition. 


POSTURE.  123 

As  a  matter  of  curiosity,  I  will  cite  the  title  of  a  work 
published  in  1637,  in  which  it  was  warmly  advocated,  and  I 
will  add  a  brief  description  of  the  chair,  in  the  quaint  lan- 
guage of  the  book,  kindly  furnished  me  by  Dr.  Wise,  of  the 
Surgeon-general's  Library,  and  it  will  answer  for  this  as 
well  as  all  other  chairs,  and  will  serve  to  show  the  impor- 
tance attached  to  its  various  features. 

"  The  Expert  Midwife  :  or,  an  Excellent  and  most  neces- 
sary Treatise  of  the  Generation  and  Birth  of  Man.  Wherein 
is  contained  many  very  Notable  and  Necessary  Particulars 
requisite  to  be  knowne  and  practiced :  with  Divers  Apt  and 
Useful  Figures  appropriated  to  this  Worke.  Also  the 
Causes,  signes,  and  Various  Cures,  of  the  most  Principall 
Maladies  and  Infirmities  incident  to  Women.  Six  Books 
compiled  in  Latine  by  the  Industry  of  James  Rueff,  a 
Learned  and  Expert  Chirurgion  :  and  now  translated  into 
English  for  the  Generall  Good  and  Benefit  of  this  Nation." 

"  Let  the  stoole  be  made  compassewise,  under-propped 
with  foure  feet,  the  stay  of  it  behind  bending  backward, 
hollow  in  the  midst,  covered  with  a  blacke  cloth  under- 
neath, hanging  downe  to  the  ground,  by  that  meanes  that 
the  labouring  woman  may  be  covered,  and  other  women 
sometimes  apply  their  hands  in  any  place,  if  necessity  re- 
quire. Let  the  stoole  be  furnished  and  covered  with  many 
cloths  and  clouts  at  the  back  and  other  parts,  that  the  la- 
bouring woman  receive  no  hurt,  or  the  infant  anywhere, 
strongly  kicking  and  striving  because  of  the  paines,  stir- 
rings and  motions  of  the  mother.  And  after  the  labouring 
woman  shall  be  set  in  her  chaire  about  to  be  delivered,  the 
midwife  shall  place  one  woman  behind  her  back  which  may 
gently  hold  the  labouring  woman,  taking  her  by  both  the 
armes,  and  if  need  be,  the  pains  waxing  grievous,  and  the 
woman  labouring,  may  stroke  and  presse  downe  the  wombe, 
and  may  somewhat  drive  and  depress  the  infant  downward. 
But  let  her  place  other  two  by  her  sides,  which  may  both, 
with  good  words,  encourage  and  comfort  the  labouring  wom- 
an, and  also  may  be  ready  to  helpe  and  put  to  their  hand 
at  any  time.     This  being  done,  let  the  midwife  herselfe  sit 


124 


LABOR:   AN  ETHNOLOGICAL  STUDT. 


Stooping  forward  before  the  labouring  woman,  and  let  her 
annoint  her  own  hands,  and  the  womb  of  the  labouring 
woman,  with  oile  of  lillies,  of  sweet  almonds,  and  the  grease 
of  an  hen,  mingled  and  tempered  together.  For  to  doe 
this,  doth  profit  and  help  them  very  much  which  are  gross, 
and  fat,  and  them  whose  secret  parts  are  strict  and  narrow,' 
and  likewise  them  which  have  the  mouth  of  the  matrix 
dry,  and  such  women  as  are  in  labour  of  their  first  child." 


Fig.   37.  —  Delivery  in  the  Obstetric  Chair;  after  Rueffius.     1637. 

The  antiquity  of  the  obstetric  chair  has  been  greatly 
overrated,  owing  to  the  misconception  or  misconstruction 
of  the  data  in  our  possession.  I  have  endeavored  to  give 
conscientiously  the  earliest  positive  references  to  the  chair 
which  we  have,  and  that,  I  think,  is  by  Moschion  in  the 
second  century ;  but  the  votive  group  from  the  temple  of 
Golgoi,  in  Cyprus  (pictured  and  described  above),  and  that 
famous  passage  from  Exodus,  both  of  which  are  quoted  as 
evidences  of  the  early  use  of  the  chair,  will,  I  trust,  cease 
to  figure  in  that  capacity. 

The  group  from  the  Cesnola  Collection  has  been  fully 


POSTURE.  125 

described  in  its  proper  place  ;  and  as  regards  that  oft- 
quoted  passage  from  Exodus  i.  15  and  16,  which  is  re- 
ferred to  by  so  many  writers  as  indicating  the  use  of  the 
obstetric  chair  among  the  ancient  Hebrews  ;  it  is  trans- 
lated by  such,  "  When  ye  do  the  office  of  midwife  to  the 
Hebrew  women,  and  see  them  upon  the  stool,  if  it  be  a  son, 
then  ye  shall  kill  him,"  etc.  I,  however,  believe,  with  Ko- 
telman,  that  that  word  "  ebnaivi,''  which  is  made  so  much 
of,  and  is  translated,  as  already  stated,  by  many  as  chair  or 
stool,  means  stones.  So  that  the  passage  would  read  :  "  When 
ye  see  the  woman  upon  the  stones."  This  would  prove,  as 
is  most  probable,  that  it  was  the  custom  of  the  ancient  He- 
brews to  be  delivered,  like  the  Arabs  of  the  present  day,  as 
observed  by  Dr.  Goguel  and  others,  in  the  squatting  pos- 
ture, seated  upon  two  stones.  These  details  are  more  in- 
teresting than  important,  and  it  will  certainly  suffice,  as  far 
as  the  antiquity  of  the  chair  is  involved,  to  state  the  fact 
that  several  Arab  authorities  recommended  the  obstetric 
chair  in  difficult  labors,  and  that  it  was  also  advocated  by 
Hippocrates  and  Soranus  among  the  Greeks,  who  were  usu- 
ally confined  in  the  semi-recumbent  position,  often  in  bed. 
These  are  the  first  authentic  statements  as  to  its  use.  Its 
history  has  been  a  checkered  one.  At  the  present  day,  the 
obstetric  chair  is  popularly  used  only  among  .the  nations  of 
the  East,  and,  as  Ploss  says,  "  It  is  remarkable  that  it 
should  be  among  the  very  people  who  rarely  make  use  of 
a  chair  for  sitting  purposes."  We  find  the  chair  now  in 
use  in  Japan  and  China,  in  Turkey,  Greece,  Assyria,  and 
Egypt.  In  Japan,  it  was  still  advocated  by  obstetricians  in 
the  last  century  ;  in  China  it  is  common  even  now,  al- 
though physicians  battle  against  it.  In  Turkey  it  is  used 
occasionally  by  certain  midwives,  as  stated  by  P.  Eram.^ 
Dr.  Denham  speaks  of  its  use  in  the  East  at  the  present 
day .2  In  Syria,  no  respectable  midwife  or  "  diyeh  "  is  without 
her  chair,  as  I  am  informed  by  Dr.  A.  J.  A.  Arbeely,  of 

^   Quelques  considerations  prat,  siir  tes  accouch.  en  Orient,  p.  407. 
2  Address  before  the  Dublin  Obstetric  Society  at  its  twenty-seventh 
annual  session. 


126 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


Damascus.  The  chair  so  used  is  different  from  any  other 
I  have  seen  described,  and  appears  to  be  a  most  practical 
contrivance,  enabling  the  woman  to  assume  various  incli- 
nations of  the  body  ;  it  is  like  a  rocking-chair  with  com- 
fortable arms,  the  seat  about  two  feet  above  the  rockers, 
and  cut  out  in  a  semicircle,  so  as  to  permit  the  expulsion  of 
the  child.  An  assistant  holds  the  parturient  woman  by  sit- 
ting behind  her,  or  at  her  side,  whilst  the  midwife  remains 
in  front  to  support  the  perineum  with  the  palm  of  her  hand, 
greased  with  lard  or  olive  oil. 

I  have  already  called  attention  to  the  fact  that  those  na- 


FiG.  38.  —  Obstetric  Chair  in  use  in  Sjrria. 

tions  who  resort  to  the  chair  in  obstetric  practice  rarely 
make  use  of  it  for  ordinary  purposes,  and  it  appears  highly 
probable  to  me  that  the  absence  of  the  rocking-chair  from 
foreign  homes  may  be  accounted  for  by  the  fact  that  the 
only  rocking-chair  of  which  they  had  cognizance  was  the 
chair  which  the  midwife  carried  from  house  to  house,  when- 
ever her  assistance  was  asked,  for  the  relief  of  the  child- 
bearing  woman  ;  this  chair  was  then  so  intimately  associ- 
ated with  the  idea  of  suffering,  of  labor,  and  child-birth,  that 
it  did  not  appear  as  a  desirable  piece  of  furniture  for  parlor 
or  sitting-room  ;  it  would  have  seemed  improper  and  out  of 
place.  For  similar  reasons  the  comfortable  arm-chair  is  an 
unknown  luxury  among  certain  Eastern  people. 


POSTURE.  127 

It  is  only  within  late  years  that  the  American  rocking- 
chair  has  found  its  way  across  the  ocean,  and  the  increased 
faciUties  for  intercourse,  and  the  spread  of  a  leveling  civili- 
zation, will  soon  do  away  with  these  remnants  of  former 
times  which  still  linger  here  and  there.  Amongst  the  mod- 
ern Egyptians,  the  midwife  makes  use  of  a  chair,  "  Kursee 
El-Wiladeh,"  which  is  covered  with  a  shawl,  or  an  embroid- 
ered napkin,  and  some  flowers  of  the  henna  tree,  or  some 
roses,  are  tied  with  an  embroidered  handkerchief  to  each 
of  the  upper  corners  of  the  back ;  thus  ornamented,  the 
chair  is  conveyed  before  the  midwife  to  the  house.  In  the 
houses  of  the  rich,  the  parturient  is  placed  on  a  bed  after 
delivery,  and  usually  remains  there  from  three  to  six  days, 
whilst  the  poor  women  resume  their  ordinary  occupation  in 
a  day  or  two.^  I  will  add  that  Lane,  like  almost  every 
other  author,  refers  to  that  passage.  Exodus  i.  i6,  intending 
to  compare  the  custom  of  using  the  chair  among  the  Egyp- 
tians with  that  of  the  ancient  Hebrews.  In  Palestine,  the 
obstetric  chair  is  still  an  honored  institution,  but  much  sim- 
plified in  form,  being  sometimes  nothing  more  than  an  old- 
'fashioned  arm-chair. 

{d.)    Semi-recumbent  Position,  Strictly  Speaking. 

Alttough  I  have  grouped  as  semi-recumbent  all  the  posi- 
tions last  spoken  of,  I  will,  in  this  subdivision,  confine  the 
use  of  the  expression  more  closely,  and  will  class  as  semi- 
recumbent,  strictly  speaking,  only  those  positions  in  which 
the  patient  assumes  the  dorsal  decubitus  with  the  head  and 
shoulders  raised,  the  axis  of  the  body  inclined  at  an  angle 
of  about  forty-five  degrees. 

Like  many  other  of  these  curious  positions,  this  one  is 
found  in  our  own  States,  but  seems  to  have  come  to  us 
from  the  French  settlers  in  the  north.  In  Vermont,  some 
thirty  years  ago,  a  semi-recumbent  position  was  customary, 
tvhich  may  either  be  looked  upon  as  a  rude  imitation  of  the 
obstetric   chair,  or   as  a  semi-recumbent   position,  strictly 

1  E.  W.  Lane,  The  Manners  and  Custotns  of  the  Modern  Egyptians^ 
vol.  ii.,  p.  306. 


128 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


speaking,  and  probably  the  custom  has  not  as  yet  entirely 
passed  away  ;  the  women  in  the  rural  districts  were  con- 
fined upon  a  bed  made  of  three  chairs  tied  together,  upon 
which  a  straw  bed  was  placed,  and  covered  with  a  sheet.  In 
front  of  this  couch  sat  two  women,  whose  duty  it  was  to 
take  the  feet  of  the  parturient  woman  in  their  laps,  whilst 
the  accoucheur  sat  between  them,  in  front  of  the  pa- 
tient, where  he  was  supposed  to  remain  for  two  or  three 
hours  during  the  latter  part  of  labor,  if  he  did  his  whole 
duty.^     The  Canadian  French  women  are  partial  to  the  in- 


FiG.  89.  —  Favorite  Posture  of  the  French  Canadian. 


clined  plane,  made  by  turning  forward  and  downward  a 
high-backed  chair,  pressing  it  back  against  the  wall  of  the 
room  and  making  a  bed  upon  it ;  though  comfortable  for 
the  patient  the  legs  of  the  attendant  suffer  from  the  stoop- 
ing posture  necessary .2 

The  custom  in  Japan,  if  I  may  judge  from  illustrations  in 
a  very  complete  "  Japanese  Midwifery,"  is  a  semi-recumbent 
position,  on  a  mattress  placed  upon  the  floor,  with  the  head 
and  shoulders  well  elevated,  so  that  the  body  is  inclined  at 
an  angle  of  about  forty  or  forty-five  degrees.  Precisely  the 
same  position  is  found  among  some  of  the  Sioux  nations, 

1  S.  S.  Clark,  M.  D.,  St.  Albans,  Vt. 

2  Dr.  John  Yale. 


POSTURE.  229 

and  the  Assneboine  Indians,  who,  as  I  am  told  by  the  well- 
known  Indian  interpreter,  F.  F.  Gerard,  lie  on  their  backs, 
the  head  and  shoulders  propped  at  an  angle  of  forty  or 
forty-five  degrees.  This  is  the  position  usually  assumed  by 
them,  although  they  are  sometimes  confined  in  the  kneeling 
posture,  like  most  Indians. 

The  Ute,  Comanche,  Apache,  Navajoe,  and  Nez-Perces 
woman  is  also  confined  in  the  semi-recumbent  dorsal  posi- 
tion, the  head  and  shoulders  of  the  patient  being  frequently 
supported  in  the  lap  of  an  attendant,  while  the  patient  has 
access  to  a  rope  or  brace  placed  within  reach. ^ 


Fig.  4«. — Japanese  Labor.    Instrumental  Delivery. 

Among  the  Pahutes,  the  parturient  woman  is  placed  in 
her  tent,  on  blankets  and  skins,  in  a  semi-reclining  position, 
with  her  hips  firm  on  the  couch  ;  she  is  supported  by  an  as- 
sistant, who  sits  behind  her,  and  in  whose  arms  she  re- 
clines ;  her  legs  are  flexed,  and  additional  assistants  hold 
and  steady  the  knees  ;  a  leather  girdle  is  fastened  about 
her  above  the  womb,  and,  as  expulsive  pains  come  on,  three 
or  more  women  push  the  girdle  down  after  the  escaping 
child.2 

The  Comanche  woman  gives  birth  to  her  child  in  some 

^  Dr.  L.  Huntington,  Surgeon  U.  S.  A. 
^  F,  R.  Waggoner,  M.  D. 


130 


LAB  OR:   AN  E  THNOL  O  GICAL  S  TUB  T. 


secluded  spot  not  far  from  the  camp,  in  the  dorsal  decubi- 
tus, on  a  low  extemporized  couch  prepared  for  her  under  a 
tree.  Upon  this  she  is  placed,  with  her  feet  against  the 
trunk  of  a  tree,  lying  on  her  back.  A  lariat,  a  small  rope 
of  buffalo  or  raw  hide,  is  thrown  over  a  branch  and  secured; 
one  end  of  it  is  placed  in  the  hands  of  the  woman,  and  she 
is  allowed  to  pull  through  as  best  she  may.^  This  would 
prove  that  during  the  pains,  and  the  expulsion  of  the  child, 
the  patient  raises  herself  by  the  lariat,  and  thus  assumes 
the  semi-recumbent  position. 

The  Hindoos  seem  to  find  the  position  convenient,  as  the 


Fig.  41. —  Penomonee  Labor. 


parturient  woman  is  delivered  while  resting  on  her  back, 
in  the  lap  of  a  female  seated  on  the  ground,  while  her  knees 
are  bent,  and  are  supported  by  two  other  females,  one  sit 
ting  on  either  side.  In  order  to  facilitate  labor  the  parts 
are  lubricated  with  oil,  and  the  "  Dyhe,"  resting  on  her 
knees  before  the  patient,  instead  of  supporting  the  peri- 
neum, urges  the  patient  to  assist  nature  in  expelling  the 
child,  while  she  introduces  the  fingers  of  her  two  joined 
hands  in  a  conical  figure  into  the  vagina,  and,  by  spreading 
them,  stretches  the  external  parts,  thinking  in  this  way  to 
facilitate  labor,  whilst   she  unquestionably  retards  it.^     I 

^  H.  S.  Kilbourne,  Assistant  Surgeon  U.  S.  A. 
2  "Notes  on  Hindoo  Midwifery"  by  Dr.  Wise,  Edinburgh  Obstet' 
rical  Society,  I2th  Session,  p.  372. 


POSTURE. 


131 


will  call  especial  attention  to  the  custom  of  the  Hoopa, 
lower  Klamath,  and  the  Orleans-Bar  tribes,  as  it  is  precisely 
the  same  as  I  have  occasionally  seen  my  patients  occupy  in 
the  efforts  of  expulsion.  Lying  on'  the  back,  the  elbows 
drawn  upwards  and  resting  on  the  ground,  the  knees  flexed 
to  a  perpendicular,  the  legs  more  or  less  flexed,  and  the 
heels  resting  on  the  ground. 

The  dorsal  decubitus,  with  the  body  at  an  angle  of  forty 
or  forty-five  degrees,  was  common  among  the  Romans. 
Moschion  describes  it.    Celsius  ^  and  Paul  of  /Egina'-^  recom- 


FiG.  42.  —  Birth  of  the  Emperor  Titus.    From  Ploss.    After  an  antique  painting  on  the  ceiling 
of  a  room  in  the  palace  of  Titus,  on  the  Esquiline  Hill  in  Rome. 

mend  this  position  in  certain  obstetrical  operations,  and 
before  the  time  of  the  obstetric  chair  it  was  commonly  as- 
sumed in  Germany.  In  some  of  the  mountainous  districts 
of  Saxony  the  patient,  semi-recumbent,  shoulders  elevated, 
is  suspended  during  the  pains  and  the  expulsion  of  the 
child,  upon  a  strong  broad  towel  which  is  placed  under  the 
pelvis  and   seems  to  further  labor   most  happily  in  fnany 


*  Lib.  7,  cap.  xxix. 


2  Cap.  vi.,  p.  74- 


132  LABOR:   AN  ETHNOLOGICAL  STUDY. 

cases.i  The  Gurian  women  take  the  dorsal  decubitus,  but 
at  the  moment  of  expulsion  seize  a  rope  suspended  above 
the  bed  and  raise  the  body  to  the  same  angle  which  we 
have  found  among  so  many  other  people. 2  Most  reasonable 
of  all  seems  the  semi-recumbent  position  as  occasionally 
adopted  in  the  rural  districts  of  this  country ;  the  patient 


Fig.  43.  —  Virginia.     Semi-recumbent  in  bed. 

being  upon  a  bed  doubled  up  against  inverted  chairs,  the 
feet  resting  against  the  foot  board,  sheets  or  towels  being 
fastened  to  the  bed  posts. 

A  truly  semi-recumbent  position  is  that  of  the  Boeathies^ 
or  red  Indians  of  New  Foundland,  which  is  thus  some- 
what quaintly,  but  very  well,  described  by  Cormack,  who 
says:  "  The  patient  is  on  her  back,  semi-recumbent  on  the 
ground,  feet  and  knees  against  two  cross  stakes.  There  is  a 
hole  dug  in  the  ground  in  front,  and  the  chief  accoucheur,  a 
female,  sits  in  the  hollow,  it  being  a  mere  convenience. 
Another  hollow  in  the  ground  is  made,  a  short  distance  be- 
yond, for  another  female  assistant  to  sit  in  for  the  purpose  of 

^  Dr.  Leopold,  N.  Ztschr.  f.  Geburtsk.,  xxv.,  3.  1849. 

2Ploss,  43. 

3  Dr.  Alfred  J.  Harvey,  of  Newfoundland,  sends  me  this  interesting 
notice  in  the  handwriting  of  Cormack,  a  traveller  who  in  1827  visited 
the  country,  and  who  was  the  first  man  to  cross  and  explore  the  island. 
The  account  has  never  been  published,  having  beeu  recently  discov- 
ered and  placed  in  the  doctor's  hands. 


POSTURE.  133 

supporting  the  patient's  head.  After  delivery  the  patient  is 
turned  around,  and  placed  in  a  kneeling  posture  within  the 
upright  stakes.  Her  buttocks,  too,  rest  on  one  cross  stick 
and  her  body  on  anotlier,  which  is  placed  under  her  breast ; 
and  in  this  position  the  patient  remains  three  or  four  days 
until  well,  receiving  the  necessary  attention  from  the  female 
accoucheur  during  this  time." 

Among  the  Turks,  also,  the  semi-recumbent  position  pre- 
vails, but  more  erect,  seated  on  ground,  stool  or  chair.' 
Their  customs   are   extremely  interesting,  as  in  many  of  the 
interior  provinces  they  still  cling  to  their  primitive  ways. 

During  the  fifth  or  sixth  month  of  pregnancy  the  abdomen 
is  compressed  by  a  firm  bandage,  and  this  pressure  is  kept  up 
until  full  term  to  prevent  the  child  from  growing  too  large. 
Abortion  is  frequent^  and  is  produced  by  breaking  the  mem- 
branes nnd  allowing  the  water  to  escape.  Delivery  is  always 
accomplished  on  the  lap  of  an  assistant,  or  seated  in  a  semi- 
recumbent  position  on  a  bed  or  low  stool,  or  even  on  the 
ground,  leaning  against  the  stump  of  a  tree  or  the  wall  of 
a  house,  or  some  other  convenient  point.  Thus  we  may  say 
that  it  is  always  a  sitting  posture,  either  upon  the  lap  of  an 
assistant,  upon  the  ground,  or  upon  the  obstetric  chair. 

Until  recently,  and  even  now  in  distant  villages,  it  is  still 
the  custom  for  the  midwife  to  carry  with  her  the  obstetric 
chair.  This,  according  to  my  informant,  is  of  a  peculiar  kind ; 
a  large,  wooden  seat,  back  chair  with  a  circular  opening  cut 
into  the  front  part  of  the  seat,  in  this  differing  from  all 
known  forms  of  the  obstetric  chair,  which  consist  of  a  mere 
semi-circular  excavation  in  the  seat,  this,  however,  being  a 
complete  circle.  This  carrying  about  of  the  chair  is  the  same 
custom  which  we  have  referred  to  in  Syria  and  other  Eastern 
countries,  although  the  shape  of  the  chair  is  different.  In 
difficult  labor  the  patient  is  placed  upon  a  blanket  held  by 
four  or  six  persons,  and  upon  this  she  is  rolled  about,  not 
tossed  up  and  down  as  we  have  seen  it  customary  in  other 
countries. 

iDr.  M,  Tsakyroglous. 


1 34  ^'-^B OR:  AN  E  THNOL  O GICAL  S  TUD  T. 

During  the  earlier  stages  the  patient  lies  at  will,  usually  on 
her  back,  on  a  mattress  placed  on  the  ground ;  as  labor 
advances,  and  the  pains  increase,  one  of  the  stronger  of  the 
women  present  takes  the  parturient  on  her  lap,  compresses 
the  abdomen  by  her  encircling  arms,  and  urges  the  sufferer 
to  bear  down  with  all  her  weight.  Various  other  methods 
are  resorted  to  for  the  purpose  of  increasing  the  pains  :  thus 
the  bent  knees  of  the  patient  are  constantly  and  severely 
jarred,  or  cold  water  is  forcibly  thrown  upon  the  abdomen. 

Their  midwives  are  very  fond  of  endeavoring  to  hasten  labor 
by  prematurely  rupturing  the  membranes,  cutting  them  with 
a  sharp  piece  of  salt — often  cutting  into  the  scalp  as  well. 

The  root  of  the  Alizari  (rubia  tinctoria)  is  considered  as 
an  emenagogue  by  the  nomadic  Turucks,  and  during  child- 
bed the  same  remedy  is  resorted  to  to  call  forth  the  lochia 
when  once  checked. 

In  former  times  bleeding  during  pregnancy  was  resorted  to 
with  a  view  of  preventing  convulsions  of  the  new-born,  but 
is  now  pretty  well  given  up. 

C.  HORIZONTAL,  OR  RECUMBENT. 
We  finally  come  to  the  horizontal  or  recumbent  position, 
and  by  this  I  mean  especially,  i.  The  Dorsal  Decubitus,  the 
obstetric  position  of  the  present  day  on  the  continent  oi 
Europe  and  in  America,  the  head  merely  elevated  by  the 
ordinary  pillow  ;  2.  The  Position  on  the  Side,  as  customary 
in  England;  and    3.    Horizontal,    Prone  on   the  Chest  and 

Stomach. 

I .    TJie  Dorsal  Dcciibitics. 

The  semi-recumbent  position  held  sway  in  Europe  before 
the  time  of  the  obstetric  chair,  and  after  a  period  of  great 
popularity  soon  disappeared,  although  its  traces  remained, 
especially  in  the  slowly  progressing  country  districts,  until 


POSTURE.  135 

the  last  thirty  or  forty  years,  when  it  finally  yielded  com- 
pletely to  the  dorsal  decubitus,  which  is  now  almost  uni- 
versal among  civilized  people.  In  England,  where,  how- 
ever, it  has  now  yielded  almost  entirely  to  the  left  lateral 
position,  it  began  to  grow  in  favor  in  the  beginning  of  the 
last  century  ;  in  Scotland  toward  the  end  of  that  century. 
White,  of  Manchester,  it  may  be  of  interest  to  note,  was 
the  first  to  advocate  the  dorsal  and  lateral  decubitus  in 
England  (i773)- 

The  Chinese  women  are  frequently  confined  in  bed.^ 
Although  this  is  the  position  which  is  taught  by  the  laws 
of  modern  obstetrics,  so  perfect  in  all  other  respects,  nature 
does  not  seem  to  have  designed  that  woman  should  in  this 
way  free  herself  from  her  burden ;  at  least  it  appears  very 
strange  that  instinct,  the  correct  guide  of  uncivilized  peo- 
ple, should  so  rarely  lead  them  to  adopt  the  recumbent  po- 
sition ;  and  it  appears  strange  that,  notwithstanding  the 
most  careful  inquiry  as  to  the  position  adopted  by  the 
savages,  and  notwithstanding  the  information  I  have  re- 
ceived from  surgeons  who  have  come  in  contact  with  all 
of  our  Indian  tribes,  I  have  found  scarcely  any  who 
assume  a  strictly  recumbent  position.  Among  some  the 
women  are  confined  in  the  dorsal  decubitus,  but  rarely 
in  the  horizontal  position.  Among  the  Cheyennes  and 
Arapahoes  we  sometimes  find  the  dorsal  decubitus  in 
simple  labors.^  The  Oregon  Indians  on  the  Siletz  Res- 
ervation are  invariably  confined  on  the  back  with  the  feet 
drawn  up.  I  am  also  told  that  others  of  the  tribes  on  the 
Pacific  coast  follow  this  custom,  especially  those  of  the 
Grand  Ronde  Agency,  Oregon  ;  the  parturient  usually 
keeps  on  her  feet  during  the  first  stage  of  labor,  but  when 
the  expulsion  pains  set  in  she  lies  on  her  back,  her  head 
very  slightly  elevated  (her  bed  always  on  the  floor),  her 
thighs  well  flexed  on  the  abdomen  ;  an  assistant  supports 
each  knee  and  foot  ;  the  patient  presses  her  hands  against 
her  thighs,  or,  when  the  pains  become  severe,  she  presses 

1  Dabry,  La  Medicme  chez  Us  Chinois,  Paris,  1863,  p.  354. 
a  J.  H.  Bannister,  M.  D. 


136  LABOR:   AN  ETHNOLOGICAL  STUDY. 

upon  the  fundus  uteri ;  later  an  assistant  carefully  manipu- 
lates the  fundus  and  follows  the  uterine  globe.'' 

The  Nez-Perces  and  Gros-Ventre  squaw  assumes  the 
stooping  posture  during  the  earlier  stages  of  labor,  with  an 
assistant  at  her  back,  who  clasps  her  body  with  her  arms, 
and  locking  the  fingers,  brings  the  palms  of  the  hands  over 
the  base  of  the  uterus,  making  steady  pressure  backwards 
and  downwards  during  the  pains  ;  in  some  instances,  dur- 
ing the  stage  of  expulsion,  however,  the  patient  lies  down 
indifferently  on  either  side  or  on  the  back,  while  if  on  the 
side,  pressure  by  the  hands  of  the  assistant  is  kept  up  con- 
tinuously, if  on  the  back,  the  assistant  remains  by  the  side 
of  the  patient  and  keeps  up  the  pressure  in  the  before- 
mentioned  directions. 

Upon  the  Antilles  the  recumbent  position  is  also  as- 
sumed, though  we  have  seen  that  other  postures  are  equally 
common  there.  Among  one  of  the  African  tribes,  the 
Wanika,  the  parturient  woman  lies  flat  upon  her  back,  and 
this  is  perhaps  the  only  instance  where  the  horizontal  po- 
sition is  so  decidedly  described.^  Of  the  Indian  women, 
Susruta  says,  page  368,  "  When  the  child  is  to  be  born,  let 
the  woman  be  placed  with  the  back  upon  a  carefully  spread 
couch,  giving  her  a  pillow,  let  the  thighs  be  flexed,  and  let 
her  be  delivered  by  four  steady,  aged,  and  knowing  mid- 
wives  whose  nails  are  well  trimmed." 

In  Southern  India  we  find  a  similar  custom  to  that  ob- 
served among  the  Nez-Perces  ;  the  patient  walks  about  in 
the  earlier  stages,  then  sits  down  with  the  legs  stretched, 
her  back  supported  by  an  assistant,  whilst  in  the  moment 
of  expulsion  she  is  placed  upon  her  back.^ 

In  Siam  the  patient  is  placed  upon  her  back  with  a  woman 
seated  upon  either  side ;  these  two  assistants  begin  by  for- 
cibly pressing  the  abdomen  downward  and  backward,  the 
pressing  of  which  is  continued  from  three  to  five  hours. 
If  by  that  time  it  has  failed  to  expel  the  fetus,  one  attend- 

1  Dr.  J.  Fields. 

2  Hildebrandt. 

0  Shortt,  Edinb.  M.  J.,  Dec,  1862,  p.  554. 


POSTURE. 


137 


ant  is  supported  by  the  hand  while  she  tramps  the  abdomen 
of  the  patient,  always  placing  her  feet  above  the  fetus,  as  a 
dernier ressort.  All  other  means  having  failed,  they  suspend 
the  parturient  by  means  of  a  band  beneath  the  arms,  as  we 
have  already  mentioned.^ 

The  Burmese  practice  is  to  strip  the  patient  naked  and 
to  compel  her  to  run  about  the  room,  while  half  a  dozen 


'  ...i^M'lililirni 


.   ^ 

■ 

.'^  r  y 

w^}\T\     \ 

Fig.  44.  —  Couch  and  Lying-in  Chamber  of  the  Siamese.     From  Ploss. 

women  are  about  who  squeeze  her  abdomen  and  beat  it 
with  pillows ;  this  process  is  continued  until  finally  she  falls 
upon  the  floor  exhausted,  and  some  of  the  women  still  keep 
pressing  the  child  down  with  their  hands,  trying  to  expel  it 
forcibly ;  and  there  are  instances,  as  the  author  is  credibly 
informed,  in  which  the  woman  is  placed  upon  her  back  and 
the  midwife  sits  upon  her  or  stands  up  and  presses  against 
the  child  with  one  of  her  feet.^ 

In  Australia  other  positions  are  assumed  in  simple  labor, 

^  "  Siamese  Obstetrics,"  by  W.  L.  Huntington,  of  Bangcock,  Siam. 
Afed.  J?ec.,  N.  Y.,  1876,  p.  133. 
3  fficiia  y.  M.  Sc,  Jan    i,  1835,  p.  339. 


138  LABOR:   AN  ETHNOLOGICAL  STUDY. 

but  it  seems  that  in  difficult  cases  the  parturient  woman  is 
treated  in  the  same  barbarous  way.  She  Hes  upon  her  back 
between  two  assistants,  one  of  whom  places  her  knee  in  the 
small  of  the  patient's  back,  whilst  the  other,  lying  more  in 
front,  awaits  a  labor  pain  and  then  presses  her  knees  into 
the  patient's  abdomen.^ 

In  Astrakhan  the  Russian  women  are  made  to  walk 
about  unceasingly  during  the  earlier  stages,  and  only  at 
the  very  last  moment  are  permitted  to  lie  down. 

In  Sumatra,  if  we  may  judge  from  a  single  case,^  the  pa- 
tient is  also  confined  in  the  recumbent  position  ;  and  in 
Brazil,  according  to  an  old  authority  cited  by  Ploss,^  the  na- 
tive women  were  confined  upon  the  ground.  Several  other 
such  vague  authorities  are  cited,  but  they  are  hardly  suffi- 
ciently reliable  for  our  purpose. 

2.    The  Lateral  Decubitus. 

The  position  upon  the  side  seems  almost  entirely  a  prod- 
uct of  modern  civilization,  and,  I  must  say,  of  prudery  rather 
than  science ;  it  is  not  adopted  as  the  obstetric  position  by 
any  of  those  people  who  still  lead  a  natural  life,  though  as- 
sumed, in  a  few  rare  instances,  in  certain  stages  of  labor. 
The  Nez-Perces  squaws  squat  in  the  earlier  stages,  and  lie 
upon  the  side  or  back  during  the  expulsion  of  the  child. 
The  Modocs,  on  the  contrary,  first  lie  upon  the  side,  and  at 
the  last  moment  take  the  knee-hand  position.  The  women 
of  the  Laguna  Pueblo,  New  Mexico,  who  follow  their  own 
inclination  almost  altogether  in  the  position  which  they  as- 
sume, stand  or  walk  about  in  the  early  stages,  but  are  con- 
fined standing,  suspended  in  a  half  squatting  position,  or,  if 
tired,  on  the  back  or  side,  with  pillows  between  the  knees  ; 
this  latter  position  is  also  occasionally  found  among  the 
Kootenai  Indians,  of  Washington  Territory ;  as  Dr.  Mor- 
gan writes,  the  woman  is  placed  on    her  left   side,  under 

^  Marston,  Journal  of  the  Ethnological  Society,  London,  i869-7(X 
Ploss,  p.  14. 

2  Monatschr.f.  Geburtsk.  n,  Frauenkr.,  viii.,  p.  3. 
*  Jean  de  Laet,  1640. 


POSTURE.  139 

which  is  placed  a  pillow,  or  bundle  of  skins  ;  another  roll  of 
skins,  or  a  blanket,  is  between  her  knees,  which  are  sepa- 
rated, so  as  to  be  about  a  foot  apart ;  the  patient  holds  a 
stake  or  cord,  the  arms  are  flexed,  and  the  head  touches  the 
hands. 

With  the  exception  of  these  few  data,  I  can  find  no  other 
reference  to  this  position. 

3.    Prone  upon  the  Stomach. 

This  peculiar  position  has  but  few  adherents  ;  in  fact,  I 
can  find  no  traces  of  it  elsewhere  than  among  the  Creeks, 
who  assume  an  over-done  knee-chest  position  ;  i.  e.,  prone 
upon  chest  and  stomach,  in  ordinary  cases.  "  When  the 
fetus  is  about  to  be  expelled  the  mother  straps   the  belt 


Fig.  45.  —  Ciow-Creek.     Prone  upon  face  and  abdomen,  across  a  pillow. 

across  her  chest,  allowing  it  to  extend  somewhat  on  to  the 
abdomen.  As  the  labor  proceeds  the  strap  is  buckled 
tighter  and  tighter,  until  the  expulsion  is  accomplished  ; 
meantime  the  position  assumed  by  the  mother  is  prone 
upon  her  face,  her  chest  and  abdomen  across  the  pillow  ;  in 
this  position  she  remains  until  the  expulsion.  She  then 
stands  up,  resting  on  a  stick  of  some  sort,  with  the  feet 
spread  wide  apart.  This  is  to  let  the  blood  flow  more 
freely,  and,  so  they  think,  to  allow  the  placenta  to  be  more 
rapidly  and  easily  delivered."  ^ 

Upon  the  Island  of  Ceram,  as  well  as  in   Loango,  and 
other  districts  of  Central  Africa,  the  patient  is  placed  upon 
her  stomach  if  labor  does  not  progress  in  the  ordinary  posi- 
'  Dr.  M.  P.  Pomeroy,  Crow-Creek  Agency,  D.  T. 


140  LABOR:   AN  ETHNOLOGICAL  STUDY. 

tion,  and  the  expulsion  of  the  child  is  hastened  by  knead- 
ing or  tramping  upon  the  back  of  the  sufferer. 

A  peculiar  custom  may  yet  be  mentioned  which  is  still 
observed,  to  the  great  discomfort  of  the  parturient  woman, 
among  some  of  our  western  Indians,  as  well  as  among  the 
more  civilized  natives  of  Syria ;  and  that  is,  to  toss  the  suf- 
fering patient  in  a  blanket,  the  four  corners  of  which  are 
held  by  stout  men,  so  that  she  is  well  shaken,  with  a  view, 
probably,  of  rectifying  the  malposition,  and  shaking  out  the 
fetus  from  the  unwillino:  womb. 


PART    II. 


The   Position    of  Women   among    Civilized  Races    of  the 
Present  Day  in  the  Agotiy  of  the  Expulsive  Pains. 

Abler  obstetricians  than  myself  have  undoubtedly  under- 
stood the  movements  of  women,  and  the  positions  which 
they  assumed  in  the  agony  of  the  expulsive  pains.  As  re- 
gards myself,  I  must  candidly  confess  this  was  not  the  case  ; 
and  it  was  not  until  I  had  undertaken  this  work,  and  had 
begun  to  study  the  positions  assumed  by  savage  and  civil- 
ized people  during  labor,  that  I  began  to  understand  that 
there  was  a  method  in  the  instinctive  movements  of  women 
in  the  last  stage  of  labor.  I  had  seen  them  toss  about,  and 
sought  to  quiet  them  ;  I  bade  them  have  patience,  and  lie 
still  upon  their  backs  ;  but,  since  entering  upon  this  study, 
I  have  learned  to  look  upon  their  movements  in  a  very  dif- 
ferent light.  I  have  watched  them  with  interest  and  profit, 
and  believe  that  I  have  learned  to  understand  them.  It 
has  often  appeared  to  me,  as  I  sat  watching  a  tedious  labor 
case,  how  unnatural  was  the  ordinary  obstetric  position  for 
che  parturient  woman  ;  the  child  is  forced,  I  may  say,  up- 
wards through  the  pelvic  canal  in  the  face  of  gravity,  which 
acts  in  the  intervals  between  the  pains,  and  permits  the 
presenting  part  of  the  child  to  sink  back  again,  down  the 
inclined  canal.    If  we  look  upon  the  structure  of  the  pelvis, 


POSTURE. 


141 


more  especially  the  direction  of  the  pelvic  canal  and  its 
axis,  if  we  take  into  consideration  the  assistance  which 
may  be  rendered  by  gravity,  and,  above  all,  by  the  abdomir 
nal  muscles,  the  present  obstetric  position  seems  indeed  a 
peculiar  one. 

The  contractions  of  the  previously  inactive  and  rested 
abdominal  muscles  are  a  powerful  adjunct  to  the  tired  ute- 
rine fibre,  in  the  last  prolonged  and  decisive  expulsory  ef- 
fort, and  in  the  dorsal  decubitus  they  are  somewhat  ham- 
pered ;  they  act  to  the  best  advantage  in  the  inclined  po- 
sitions, semi-recumbent,  kneeling,  or  squatting.  We  know 
that  the  squatting  position  is  the  one  naturally  assumed  if 
an  effort  is  required  to  expel  the  contents  of  the  pelvic 
viscera ;  we,  moreover,  all  know  how  difficult,  even  impos- 
sible, it  is  for  many  to  perform  those  functions  recumbent 
in  bed,  and  mainly  because  they  have  not  sufficient  control 
of  the  abdominal  muscles  in  that  position.  Much  more  is 
this  the  case  in  the  expulsion  of  the  child  ;  but  the  recum- 
bent position  is  sanctioned  by  custom  ;  it  is  pointed  out 
as  apparently  convenient ;  it  is  imperatively  demanded  by 
prudery,  and  by  a  false  modesty  which  hides  from  view  the 
patient's  body  beneath  the  bed-clothes  ;  and  above  all  it  is 
dictated  by  modern  laws  of  obstetrics,  the  justice  of  which 
I  have  never  dared  question ;  we  have  all  been  taught  their 
correctness,  and  we  all  thoughtlessly  follow  their  dictates. 
There  is  no  reason  for  assuming  this  position,  though  we 
are  taught  it ;  it  is  not  reason,  or  obstetric  science,  but 
obstetric  fashion  which  guides  us,  —  guides  us  through  our 
patients  ;  and  blindly  do  we,  like  all  fashion's  votaries,  fol- 
low in  the  wake. 

We  have  seen  in  the  first  part  of  this  paper  that  the  re- 
cumbent position  is  one  but  rarely  taken  by  women  among 
savage  tribes,  ok  among  people  who  still  follow  their  in- 
stinct and  not  the  dictates  of  the  latest  obstetric  fashion. 
Now  what  does  civilized  woman  in  the  hands  of  the  mod- 
ern obstetrician  do  when  in  the  intense  agony  of  the  last 
expulsive  pains }  She  loses  control  of  herself,  forgets  the 
admonition  of  her  physician,  and  gives  way  to  her  own  in- 


142 


LABOR:   AN  ETHNOLOGICAL  STUDY. 


stinct.  You  have  all  seen  what  I  have  learned  to  under 
stand  but  recently.  The  parturient  woman,  at  the  time  of 
the  expulsive  pains,  raises  herself  in  bed  into  a  semi-recum- 
bent position  upon  her  hands  or  elbows.  This  struck  me 
most  forcibly  when  I  observed  this  motion  in  a  young  pri- 
mipara  who  had  gone  through  the  earlier  stages  of  labor 
bravely,  and  although  partially  under  the  influence  of  chlo- 
roform, when,  with  the  last  severe  pains  the  head  of  the 
child  would  advance  and  then  again  recede,  she  finally,  in 


8    a 


Fig.  46.  —  Semi-recumbent,  in  the  agony  of  the  expulsive  effort 


her  agony  raised  herself  up  into  a  semi-recumbent  position, 
resting  on  her  arms,  and  with  the  next  pain  the  child  was 
born. 

Other  women  assume  this  semi-recumbent  position  by 
clinging  to  the  neck  of  the  husband,  or  an  assistant  who 
may  be  seated  by  the  bedside.  It  is  not  love  for  the  per- 
son which  dictates  this  motion  ;  it  is  an  instinctive  desire 
to  raise  herself  into  a  semi-recumbent  position,  to  facilitate 
the  expulsion  of  the  burden  she  bears.  Others,  again,  have 
a  sheet  or  rope  fastened  to  the  bedpost,  upon  which  they 
pull  with  their  arms  ;  the  object  of  this  is  only  to  assist  in 
the  effort  of  raising  herself  partially  in  bed,  into  a  semi-re- 
cumbent position,  as  the  kneeling  savage  raises  herself  by 


POSTURE.  143 

a  rope  which  is  fastened  above  her  head,  or  as  others  re- 
cumbent in  bed  or  upon  the  floor,  half  raise  themselves 
by  a  rope  or  pole  above  the  head.  It  was  instinct,  cer- 
tainly not  obstetric  teaching,  which  told  the  patients  re- 
ferred to  by  Dr.  Campbell  to  assume  the  squatting  position 
by  which  they  were  so  easily  delivered  of  their  children, 
Vv'hilst  tedious  labor  stared  them  in  the  face  if  they  obeyed 
the  modern  obstetric  fashion.  In  one  case  it  was  a  negro, 
in  the  other  it  was  a  white  woman  of  high  social  standing, 
who  had  suffered  in  several  tedious  labors  while  obliged  to 
follow  the  dictates  of  her  physician  to  remain  in  her  bed ; 
in  her  agony,  following  her  instinct,  regardless  of  advice  or 
appearances,  she  assumed  the  squatting  position,  and  was 
easily  delivered.  In  another  case  Dr.  Campbell  refers  to  a 
girl  whom  he  had  lately  confined  icneeling  upon  the  floor, 
her  arms  resting  upon  a  low  rocking-chair.  Being  asked 
how  she  came  to  assume  this  position,  she  said  that  in  a 
former  labor,  four  years  ago,  the  midwife  had  kept  her 
strictly  in  bed,  never  allowing  her  to  get  up ;  this,  however, 
she  was  able  to  do  occasionally,  when  the  pains  always 
seemed  to  improve.  She  said  that  the  midwife  threatened 
to  tie  her  in  bed  if  she  did  not  remain  quiet.  She  was,  upon 
that  occasion,  in  labor  from  four  o'clock  in  the  afternoon 
until  ten  o'clock  of  the  second  day ;  being  in  great  distress, 
she  disobeyed  the  midwife,  and  left  her  bed  ;  her  pains  im- 
mediately increased,  and  she  knelt  down  on  the  floor  with 
her  face  resting  in  the  lap  of  her  mistress,  and  was  in  the 
same  position  as  with  the  chair  in  the  following  labor ;  she 
says  that  she  had  not  been  in  that  position  more  than  five 
minutes  before  the  child  was  born.  Her  expression  was, 
"  The  floor  is  the  best  place  to  have  a  baby,  and  I  don't 
think  I  ever  could  have  one  in  bed."  The  woman  seemed 
quite  intelligent,  and  afterwards  candidly  stated  that  her 
first  thought,  on  the  doctor's  entering  the  room,  was  a  dread 
that  she  would  be  put  to  bed  and  stopped  from  completing 
her  labor- 

I  need  hardly  continue  this  evidence,  as  every  one  of  the 
members  is  aware  how  frequently,  in  the  last  moments,  a 


144  LABOR:   AN  ETHNOLOGICAL  STUDY. 

change  of  position  is  made  by  the  agonized  woman.  Rarely 
the  inclined  position,  kneeling,  or  squatting,  is  assumed, 
mostly  the  semi-recumbent  position,  and  that  is  the  one 
which  seems  dictated  by  the  instinct  of  the  patient,  and 
the  one  which  I  would  accordingly  advocate. 


RESUME   AND    CONCLUSIONS. 

I  WILL  briefly  recall  the  more  striking  and  important 
features  elicited  in  the  inquiries  I  have  made  in  regard  to 
the  posture  of  women  in  labor. 

I.  The  women  of  the  various  tribes  and  races  are  deliv- 
ered according  to  customs,  and  in  positions,  wJiich  are  pecul- 
iar to  their  people,  whenever  they  are  free  to  follow  their 
own  instincts. 

(a.)  These  positions  are  now  adopted  as  customary  and  tradi- 
tional, but  in  the  first  place  they  were  assumed  because  they  had 
proved  the  safest  and  best ;  delivery,  in  simple  cases,  being  thus 
accomplished  in  the  shortest  possible  time  with  the  least  possible 
suffering. 

(d.)  So  great  do  the  advantages  of  posture  in  childbirth  seem 
to  be,  that  people  cling  to  this  custom  more  firmly  than  to  any 
other  of  their  traditions,  as  we  have  seen  by  the  chair  of  the 
Cypriote  midwife,  who  to-day  reenacts  the  labor  scene  of  2,300 
years  ago ;  and  of  the  native  Peruvian  woman,  who  is  still  con- 
fined as  were  her  ancestors  at  the  time  of  the  Incas. 

II.  The  positions  asstmied  in  civilized  communities,  by 
the  advice  of  learned  authorities,  have  varied  greatly  with 
the  change  in  obstetric  science,  and  witJi  the  demands  of 
cotnfort  a7td  of  modesty ;  thus,  in  the  days  of  Greece  and 
Rome,  in  the  early  centuries  of  the  Christian  era,  a  semi- 
recumbent  position  was  advocated,  either  upon  a  low  stool 
or  in  bed  ;  later  came  the  obstetric  chair,  and  toward  the 
end  of  the  last  century  the  dorsal  decubitus,  which  has  re- 
tained its  supremacy,  yielding,  however,  to  the  position  on 
the  side  in  the  British  Isles,  and  to  the  dictates  of  Nature 
in  the  agonies  of  the  expulsive  pains,  when  women  will  00 


POSTURE.  245 

casionally  disobey  the  conscientious  obstetrician,  that  they 
may  obtain  speedy  relief. 

III.  The  same  ivomaji  often  assumes  various  position  in 
the  course  of  a  natural  labor;  usually,  she  is  more  at  her 
ease  in  the  early  stages,  and  not  until  the  pains  become  more 
regular,  rapid,  and  severe,  does  she  take  the  position  in  which 
she  is  confined. 

Thus,  the  Coyotero- Apache  squaw  occupies  any  position 
she  pleases,  generally  standing  or  walking  about  until  bear- 
ing-down pains  supervene  (which,  in  fact,  is  almost  uni- 
versal among  the  North  American  Indians),  then  she  as- 
sumes the  squatting  posture.  The  squaws  of  the  Laguno 
Pueblo  stand  with  their  hands  on  their  knees,  much  as  they 
urinate,  in  the  earlier  stages  ;  later,  they  stand  up  erect, 
supported  by  assistants  or  clinging  to  a  rope.  The  Modocs 
maintain  a  curved  position,  lying  on  the  side,  until  the 
labor  is  nearly  completed,  when  they  assume  a  position  on 
their  knees  and  hands,  which  is  continued  until  the  child  is 
born. 

Among  the  Nez-Perces  and  Gros-Ventres  the  parturient 
is  in  a  stooping  posture  during  the  first  two  stages  of  labor, 
the  buttocks  resting  on  the  heels,  whilst  during  the  expul- 
sion of  the  child  she  lies  down,  on  either  side,  or  on  the 
back. 

IV.  In  the  last  stages  of  ordinary  labor,  those  positions, 
winch  I  have  classified  as  inclined  are  most  frequently  re- 
sorted to;  most  common  of  all  is  the  kneeling  position, 
which  we  mainly  find  among  the  Tartars,  Mongolians,  and 
North  American  Indians :  the  squatting  posture  is  also  at 
home  among  our  Indians,  and  among  the  Malays,  the  Aus- 
tralian and  African  negroes ;  equally  frequent  are  the  semi- 
recumbent  positions,  which,  although  resorted  to  by  savage 
nations,  are  more  closely  connected  with  the  progress  of 
civilization.  The  ruder  methods.^  such  as  the  semi-recum- 
bent position  in  the  lap  of  an  assistant,  or  on  the  ground, 
answer  the  same  purpose  as  the  more  comfortable  and  re- 
fined posture  in  the  obstetric  chair  or  in  bed. 

Least  frequent  are  the  recumbent  or  horizontal,  and  the 
standing  or  erect  postures. 


146  LABOR:   AN  ETHNOLOGICAL  STUDY. 

V.  In  all  positions,  whether  the  patient  is  swinging  by 
the  limb  of  a  tree,  whether  she  is  kneeling  by  a  stake,  or 
semi-recumbent  in  bed,  there  is  a  decided  change  in  the  axis 
of  the  body  during  the  pain,  and  in  the  interval  of  rest ; 
and  us7ially  the  patient  has  a  support  of  some  kind  within 
reach,  a  rope,  a  stake,  or  an  assistant,  by  means  of  which  she 
can  cJiange  the  axis  of  the  body,  and  inteJisify  the  contractions 
of  voluntary  and  i?ivoluntary  muscles  duriiig  the  pains. 

The  pelvis  itself  is 
usually  steadied, 
whilst  the  upper  por- 
tion of  the  trunk 
sways  to  and  fro. 

Some  of  our  In- 
dians walk  about  in 
the  interval,  and 
kneel  down,  clinging 
to  the  stake  during 
the  pain ;  for  this 
purpose  the  Co- 
manches,  for  in- 
stance,  have  a  num- 
ber of  stakes  planted 
in  the  ground  at  the 
place  of  confinement, 
Fig.  47.— Kneeling,  clinging  to  rope.  in  ordcr  that  the  pa- 

tient may  walk  about, 
and  still  find  a  support  to  kneel  by  at  any  moment,  when 
the  pain  overtakes  her. 

The  weakly  woman,  among  the  Kootenai  Indians,  who  is 
confined  in  a  recumbent  position,  raises  herself  by  a  rope 
which  is  suspended  above  her  during  the  severer  pains,  and 
during  the  expulsion  of  the  child. 

The  Indians  on  the  Mexican  frontier,  who  are  confined 
in  a  kneeling  position,  usually  stand  or  recline  on  the  bed 
during  the  interval  between  the  pains  ;  but  when  a  pain  is 
coming  on,  they  immediately  grasp  the  convenient  rope 
and  hang  on  with  all  their  might ;  and  this  position  permits 


POSTURE.  147 

of  the  easiest  and  freest  motion  of  the  body  for  the  purpose 
of  best  adapting  the  incHnation  of  the  pelvic  axis  to  de- 
mands of  the  advancing  head. 

The  native  Mexican  is  often  confined  kneeHng  on  the 
floor  ;  in  the  interval  between  the  pains  she  lets  herself 
down,  her  buttocks  resting  upon  her  heels,  whilst  during 
the  pain  she  raises  the  body,  throwing  it  backward  or  for- 
ward, according  to  circumstances,  and  clings  to  a  rope,  an 
assistant,  or  the  neck  of  the  midwife. 

Surgeon  George  W.  Adair,  U.  S.  A.,  justly  characterizes 
the  difference  in  the  methods  pursued  by  various  people. 
He  says  :  "  The  English  midwife  exhorts  the  patient  to 
lean  forward ;  in  America,  the  feet  are  fixed,  and  the  pa- 
tient is  given  a  rope  by  which  she  raises  herself  during  the 
pain  ;  the  Mexican  midwife  fixes  the  knees  and  holds  the 
upper  portion  of  the  trunk  as  in  a  vice,  and  pulls  the  pelvis 
forward,  hinged,  as  it  were,  upon  the  acetabulum,  and  thus 
overcomes  the  dip  of  the  plane  of  the  superior  strait,  and 
straightens  the  passage  with  greater  efficiency  and  cer- 
tainty." 

Dr.  Campbell  closely  observed  the  negro  woman  whom 
he  saw  confined  in  a  kneeling  posture,  her  arms  resting 
upon  a  low  chair,  and  saw  that  during  the  pain  her  body 
would  move  backwards  so  that  her  buttocks  would  rest  be- 
tween her  heels,  while  in  the  intervals  she  would  glide  for- 
ward again,  so  that  the  thighs  became  perpendicular  and 
the  body  horizontal. 

VI.  Ill  tedious  cases,  wheji  delivery  is  retarded  and  labor 
will  not  advance,  a  change  is  tisually  made  in  the  posttire  of 
the  patient,  and  massage  is  freely  resorted  to ;  thus,  the 
Cheyennes,  Arapahoes,  Nez-Perces,  and  Gros  Ventres,  who 
assume  the  dorsal  decubitus  in  ordinary  labor  cases,  rais- 
ing themselves  into  a  semi-recumbent  position  during  the 
expulsion  of  the  child,  resort  to  the  knee-elbow  position  in 
difficult  cases. 

The  Siamese,  who  usually  assume  the  recumbent  posi- 
tion, and  our  Coyotero-Apaches,  who  squat  in  ordinary 
cases,  both    suspend   the  parturient   by  bands   about   the 


148  LABOR:   AN  ETHNOLOGICAL  STUDY. 

chest,  if  labor  is  delayed,  and  let  several  assistants  cling  to 
the  sufferer,  suspending  themselves  from  her  with  their 
arms  above  the  uterine  tumor  ;  the  Siamese  draw  their  pa- 
tient up  in  an  erect  posture,  whilst  the  Apache  squaw  is 
swung  in  a  more  kneeling  position. 

Upon  the  Pacific  slope,  where  the  dorsal  decubitus  is  the 
rule  in  ordinary  cases,  the  patient  is  partially  suspended  in 
a  kneeling  or  squatting  position  in  difficult  cases  ;  the  Syr- 
ians, who  usually  permit  their  patients  the  comforts  of  the 
obstetric  rocking-chair,  toss  them  in  a  blanket  to  shake  the 
child  out,  or  turn  it,  if  the  labor  becomes  tedious. 

Instinct  and  experience  teach  the  savage  that  by  a  change 
of  position,  labor  may  be  hastened  or  retarded,  and  invol- 
untarily they  change  the  axis  of  the  body  in  a  way  most 
favorable  to  a  natural  and  safe  delivery,,  hastening  labor  as 
much  as  is  compatible  with  the  safety  of  mother  and  child ; 
all  the  inclined  positions,  especially  the  kneeling  and  squat- 
ting, clinging  to  a  rope,  are  such  that  the  direction  of  the 
pelvic  axis  can  be  readily  changed.  It  remains  for  the  sci- 
entific observer  to  demonstrate  with  precision  the  positions 
which  are  the  most  favorable  under  given  conditions. 

Herr  von  Ludwig,  the  speculative  and  theoretical  writer, 
who  has  been  condemned  and  ignored  by  practical  obste- 
tricians, describes  the  knee-elbow  position  as  the  one  which 
retards  the  expulsion,  making  it  slower  and  safer  in  diffi- 
cult cases,  saving  the  perineum,  and  the  kneeling  position, 
with  the  body  inclined  forward,  as  the  one  which  retards 
expulsion  but  moderately,  with  proper  care  of  the  peri- 
neum. 

Although  it  is  not  within  the  scope  of  this  study  to  dis- 
cuss the  question  as  to  the  best  position  for  women  in  labor, 
we  may  well  look  to  the  ethnological  facts  cited  for  a  solu- 
tion of  this  puzzling  and  highly  important  problem,  and  I 
will  outline  the  more  important  conclusions  which  have  de- 
veloped. 

I.  /;/  the  ordinary  labor  case.,  wJiicJi  is  a  purely  mechani- 
cal process,  the  patient  should  be  given  greater  liberty  and 
should   be  permitted  to  follow  the  dictates  of  her  ijistinct 


POSTURE.  149 

in  regard  to  her  movements   more  freely  tJiaii  is  now  cus- 
tomary. 

II.  /;/  tJie  earlier  stages  of  labor  the  parturient  must  be 
guided  in  Jier  actions,  a7id  in  the  position  assumed.,  by  her 
own  comfort  and  by  the  dictates  of  her  institict  ;  not  only  is 
this  the  invariable  rule  among  savage  races,  but  it.  was  also 
warmly  advocated  by  the  shrewd  and  observing  obstetri- 
cians of  the  past,  and  by  those  eminently  practical  and  suc- 
cessful midwives  of  old. 

III.  TJie  care  zuith  which  the  parturient  women  of  tmciv- 
ilized  people  avoid  the  dorsal  decubitus,  the  modern  obstetric 
position,  at  the  termination  of  labor,  is  sufficient  evidence  that 
it  is  a  most  undesirable  position  for  ordinary  cases  of  confine- 
ment ;  and  I  am  convinced  that  the  thinking  obstetrician  will 
soon  confirm  the  statement  not  tmfreqtiently  made  by  the 
ignorant  but  observing  savage,  by  Negro  and  Indian,  that  the 
recumbent  position  retards  labor  and  is  inimical  to  easy,  safe, 
and  rapid  delivery. 

Several  of  the  most  esteemed  of  my  colleagues  have  al- 
ready given  me  a  very  decided  expression  of  their  opinion, 
taking  the  same  grounds  practically  and  theoretically.  Dr. 
Campbell,  of  Georgia,  says  that  a  careful  study  of  the  ac- 
tions of  parturient  woman  in  her  natural  state  will  force 
us  to  permit  our  patients,  sometimes,  at  least,  to  obey  their 
own  impulses,  and  to  assume  a  squatting,  kneeling,  or  sit- 
ting posture,  in  their  attempts  to  deliver  themselves  ;  and 
this,  he  adds,  "  would,  in  my  opinion,  often  do  away  with  the 
necessity  of  resorting  to  the  forceps,  which,  though  a  great 
blessing,  too  often  become  the  reverse  in  the  hands  of  eager 
obstetricians,  who  are  inclined  to  use  them  on  the  least  oc- 
casion, or  without  any  real  occasion  at  all."  He  has  given 
me  the  history  of  a  number  of  cases,  most  of  which  I  have 
already  cited,  in  which  labor  was  retarded,  progress  had  en- 
tirely ceased,  and  the  propriety  of  the  forceps  was  under 
consideration,  when  a  speedy  and  unaided  delivery  followed 
a  change  of  position  from  the  routine  dorsal  decubitus  to 
the  squatting,  sitting,  or  kneeling  posture,  as  the  instinct  of 
the  patient  prompted  ;  but  be  it  remembered,  the  same  pa- 


150  LABOR:   AN  ETHNOLOGICAL  S2UD2. 

tient,  when  free  to  follow  her  instinct,  always  adopted  the 
same  position. 

The  cases  related  by  Dr.  Campbell  are  as  striking  as  the 
one  told  me  by  Dr.  V.  Mansfelde,  of  Kansas  :  the  patient 
being  in  great  distress,  labor  having  continued  for  several 
days,  entire  cessation  of  pains  in  the  usual  obstetric  posi- 
tion, their  sudden  recurrence  upon  assumption  of  an  in- 
clined position,  their  disappearance,  with  the  certainty  of  a 
chemical  experiment,  upon  a  return  to  the  dorsal  decubitus, 
and  final  speedy  delivery  in  the  position  of  the  patient's 
choice. 

Dr.  Wilcox,  of  Massachusetts,  and  others  have  related  sim- 
ilar cases,  most  of  which  I  have  already  given,  but  I  cannot 
close  without  again  referring  to  the  views  of  my  friend.  Dr. 
Campbell  :  "  I  will  say  that  I  regard  what  may  be  called 
the  Obstetric  position,  as  generally  practised  in  this  country, 
recumbent  on  the  back,  as  not  only  the  most  unnatural,  but 
the  most  disadvantageous  and  therefore  the  most  unphilo- 
sophical ;  it  is  the  position  which,  above  all  others,  de- 
prives the  woman  in  labor  of  the  advantages  which  gravity 
would  give  us  in  promoting  expulsion  ;  there  the  position 
almost  nullifies  the  power  of  the  abdominal  muscles,  leav- 
ing the  almost  unassisted  uterine  muscle  to  effect  expul- 
sion. The  English  method,  on  the  side  with  the  body  bent 
forward  and  the  thighs  drawn  up,  is  much  more  advantage- 
ous in  so  far  as  the  abdominal  muscles  can  act  better." 

IV.  ///  ordinary  labor  cases  the  expulsion  of  the  child 
should  be  expected  in  aji  ijiclined  position :  Kneeling,  sqjiat- 
ting  or  senii-recnmbent,  in  bed,  on  the  chair  or  lap,  as  is  done 
by  the  great  majority  of  uncivilised  people,  and  for  the  fol- 
lozving  reasons :  — 

a.  These  positions  permit  the  free  use  of  the  abdominal  mus* 
cles. 

b.  The  force  of  gravity  does  not  counteract  the  expulsive  effort 
as  in  the  recumbent  position,  nor  does  it  unite  with  it  too  freely, 
and  hasten  labor  unduly,  as  in  the  erect  posture. 

c.  With  the  assistance  of  a  rope,  stake,  or  other  support  the 
parturient  can  vary  the  inclination  of  the  body  and  correct  the 
labor,  hasten  or  retard  the  descent  of  the  child,  and  relieve  the 


POSTUIiE.  151 

pain,  changing  the  axis  of  the  body  and  throwing  the  fetal  head 
toward  the  sacrum  or  symphysis. 

d.  Injury  to  the  soft  parts  is  less  liable  to  occur  in  these  po- 
sitions, if  we  may  accept  the  rapid  getting  up,  and  freedom  of 
our  Indian  squaw  from  all  uterine  diseases,  as  proof  of  this  state- 
ment. 

V.  Of  these  positions  the  senii-rcciimbcnt  is  the  most  ser- 
viceable, and  should  be  adopted  as  the  obstetric  position  in  all 
ordinary  labor  cases ;  it  is  preferable  to  the  kneeling  or 
squatting. 

a.  As  more  convenient  and  comfortable,  not  exposing  the  per- 
son, and  not  being  objectionable  to  the  modesty  of  the  patient. 

b.  As  affording  more  rest  and  not  being  tiresome,  which  is  a 
serious  objection  to  the  kneeling  and  squatting  position  as  appli- 
cable to  the  tender  female  of  our  civilization. 

c.  The  semi-recumbent  position  in  bed,  the  body  at  an  angle 
of  forty-five  degrees,  the  hips  resting  on  a  hard  mattress,  thighs 
well  flexed,  is  the  easiest,  most  comfortable,  and  appears  to  afford 
the  greatest  relief,  and  the  greatest  freedom  from  pain,  coupled 
with  the  greatest  effect  of  the  uterine  contractions,  relaxation  of 
all  the  parts,  and  free  play  of  the  abdominal  muscles. 

d.  The  pelvis  is  more  readily  fixed  in  this  position. 

e.  The  perineum  has  a  certain  support  which  does  away  with 
the  questionable  proceeding  of  supporting  the  perineum  during 
expulsion  of  the  head  and  shoulders,  by  which  more  harm  than 
good  is  usually  done. 


CHAPTER  III: 


THE  THIRD  STAGE  OF  LABOR. 


Labor  seems  completed  with  the  expulsion  of  the  child,  the 
one  act  upon  which  the  efforts  of  the  accoucheur  and  the  ex- 
pectations of  the  patient  have  centred,  the  culmination  of  hours 
of  suffering  and  anxiety  ;  both  feel  as  if  their  work  were  com- 
pleted, and  but  little  thought  is  given  by  either  to  the  remain- 
ing afterbirth  which  is  usually  expelled  without  much  suffer- 
ing to  the  mother,  and  if  nature  be  not  interfered  with,  rarely 
calls  for  any  exertion  on  the  part  of  the  attendant. 

Accidents  occurring  during  the  birth  of  the  child  are  imme- 
diately followed  by  alarming  results,  while  those  happening 
during  the  delivery  of  the  placenta  can  be  ignored  at  the  time, 
although  the  consequences  are  often  disastrous.  The  third 
stage  of  labor  accordingly  excites  but  little  interest,  and  is,  I 
may  almost  say,  unduly  neglected ;  some  radical  changes  have 
of  late  years  been  made  in  its  treatment,  but,  although  advo- 
cated by  able  obstetricians,  they  have  by  no  means  met  with 
the  hearty  concurrence  of  the  profession  at  large,  of  which 
they  deserve  and  which  their  importance  justifies. 

My  attention  has  been  recently  directed  to  what  I  may  call 
the  natural  management  of  labor,  or  the  customs  observed  dur- 
ing childbirth  by  such  people  as  are  not  yet  governed  by 
modern  obstetric  law,  and  who  follow  the  dictates  of  instinct  in 
this  purely  mechanical  function  of  our  animal  existence ;  my 
researches  in  regard  to  the  position  of  women  in  labor  have 
shown   me  the  correctness  of  the  course  adopted  by  those 


THE    THIRD    STAGE.  153 

untutored  people  with  whom  methods  have  been  traditionary 
for  ages  which  have  not  until  now  reached  us,  in  this  advanced 
nineteenth  century,  as  the  teachings  of  our  most  scientific 
obstetricians ;  and  I  deem  it  of  interest,  if  not  of  some  little 
practical  importance,  to  study  the  management  of  the  placenta, 
indeed  the  treatment  of  the  patient  during  the  third  stage  of 
labor,  among  uncivilized  people  who  are  as  yet  forced  to  rely 
upon  their  instinct  for  their  obstetric  practice,  and  upon  whom 
the  ol)stetric  laws,  and  I  may  say  obstetric  fashions,  of  to-day 
have  not  yet  encroached.  It  is  only  of  late  that  ethnological 
studies  have  developed  and  have  brought  to  light  the  innermost 
life  and  most  private  and  secret  customs  of  those  interesting 
children  of  nature ;  but  very  little  attention  has,  however,  been 
paid  to  their  obstetric  practices,  and  above  all  to  this  very  un- 
interesting and  unimportant  detail. 

The  management  of  the  third  stage  of  labor  has  received  so 
little  attention  that  I  shall  be  obliged  to  confine  myself,  by  rea- 
son of  the  scanty  data  at  my  command,  to  the  leading  points;  I 
nevertheless  hope  to  be  able  to  develop  the  more  important  fea- 
tures sufliciently  to  show  that  these  untutored  people,  following 
the  guidance  of  instinct,  have,  as  a  rule,  pursued  a  much  more 
correct  practice  than  can  be  attributed  to  the  followers  of  scien- 
tific midwifery ;  above  all  they  have  fully  appreciated,  in  resort- 
ing to  abdominal  expression,  the  dangers  of  the  vis  a  fronte, 
and  the  importance  of  the  vis  a  tergo  as  their  main  reliance  for 
the  speedy  and  su:'cessful  removal  of  the  placenta.  Nor  are 
the  data  as  broad  as  I  should  like  to  see  them  ;  I  can  gather 
but  little  from  the  records  of  travellers  or  from  the  pages  of 
history ;  the  information  I  have  been  able  to  obtain  is  almost 
altogether  in  regard  to  the  customs  now  observed  among  the 
North  American  Indians,  and  for  this  I  am  indebted  to  the 
kindly  interest  shown  by  the  surgeons  of  the  United  States 
Army,  and  the  physicians  of  the  Indian  Agencies  who  have 
freely  responded  to  the  questions  I  have  put  in  the  circular 
sent  out  through  the  Smithsonian  Institution  by  the  generous 
offices  of  Major  J.  W.  Powell,  tlie  director,  and  others  of  the 
gentlemen  connected  with  the  Bureau  of  Ethnology,  above  all 
Dr.  H.  C.  Yarrow. 

I  shall  discuss,  first,  the  management  of  the  third  stage  of 
labor  in  simple  cases,  as  it  is  customary  among  the  various 


154  LABOR:    AN   ETHNOLOGICAL    STUDY. 

tribes,  and  this  will  be  best  understood  by  describing,  I,,  those 
methods  which  are  adopted  for  the  purpose  of  expelling  the 
placenta,  in  which  the  patient  retains  the  same  position  which 
she  occupied  in  the  delivery  of  tlie  child,  and,  of  these,  the 
one  ordinarily  practised  is  by  the  employment  of  a  vis  a  tergo, 
most  commonly  by  a  force  applied  externally  from  above  down- 
wards, by  manual  expression ;  and  secondly,  by  action  of  the 
diaphragm,  by  the  use  of  emetics.  Much  less  frequent  is  the 
employment  of  the  vis  a  fronte,  that  fatal  traction  upon  the 
cord,  which  forms  the  third  group.  Somewhat  different  from 
these  methods  is  a  fourth,  which  I  have  classified  under  IL, 
comprising  the  customs  of  all  those  tribes  who  look  upon  a 
change  of  posture  as  the  important  element  for  the  purpose  of 
accomplishing  the  expulsion  of  the  after-birth ;  a  change  of 
position  is  made  immediately  after  the  birth  of  the  child,  and 
the  patient  assumes  a  different  posture  from  the  one  occupied 
during  the  earlier  stages  of  labor.  This  is  not  frequent  in  or- 
dinary cases,  but  is  a  usual  resort  in  case  that  some  difficulty  is 
experienced  in  the  removal  of  the  placenta,  I  have  then  con- 
sidered under  different  heads  the  treatment  of  simple  and  diffi- 
cult cases,  and  will  next  review  the  management  of  the  cord, 
as  it  may  be  of  interest  to  note  the  usual  time  of  cutting  the 
cord  and  the  methods  of  cutting  and  tying  it ;  finally  I  will 
briefly  indicate  some  of  the  more  peculiar  customs,  and  the,  to 
us,  strange  views  entertained  with  regard  to  this  stage  of  labor. 

MANAGEMENT    OF    SIMPLE    CASES. 

The  placenta  delivered  in  the  same  position  which  has  heen 
occupied  during  labor  pains  and  the  expulsion  of  the 
child. 

Manual  expression. — Among  our  Indians,  as  among  all  un- 
civilized nations,  external  manipulations  are  resorted  to  wherever 
good  can  be  accomplished  by  them,  and  in  obstetric  practice  mas- 
sage and  expression  are  freely  and  effectively  used.  The  third 
stage  of  labor  is  a  very  short  one,  the  placenta  usually  escaping 
very  soon  after  the  birth  of  the  child ;  and  by  far  the  most 
common,  the  prevailing  treatment  in  fact,  is  the  one  we  will 
now  consider.  The  patient  and  her  assistants  retain  the  posi- 
tions relatively  occupied  during  the  birth  of  the  child ;  the 


THE    THIRD    STAGE.  155 

parturient,  as  is  commonly  the  case,  kneeling,  whilst  an  assist- 
ant, who  kneels  or  stands  behind  her,  with  her  arms  around 
her  waist  and  the  palms  of  her  hands  upon  the  fundus  of  the 
uterus,  keeps  up  a  steady  pressure  upon  the  contracting  organ, 
and  in  case  that  the  muscular  action  is  not  sufficient  for  the 
expulsion  of  the  after-birth,  she  hastens  its  progress  by  an 
effective  kneading.  Moreover,  we  know  that  the  kneeling, 
squatting,  and  semi-recumbent  positions  are  those  in  which  the 
abdominal  muscles  can  be  most  effectively  used  for  the  purpose 
of  expelling  any  of  the  contents  of  the  abdominal  cavity. 
This  is  true  of  the  Comanches,  of  the  Klamath,  the  Crows, 
Nez-Perces,  Peorias,  Shawnees,  of  the  Kiowa,  Caddo,  Dela- 
ware, "Wyandotte,  Ottawa  and  Seneca  tribes.  The  Klatsops 
carry  out  this  idea  perhaps  even  more  effectively  by  placing  a 
bandage  about  the  patient's  abdomen  immediately  after  the 
expulsion  of  the  child,  "  to  keep  the  placenta  from  going  back 
further  into  the  body."  And  I  may  here  state  that  this  is 
the  ruling  idea  in  their  treatment,  as  they  dread  such  an  acci- 
dent very  much,  and  unless  the  placenta  is  speedily  delivered, 
the  uterus  responding  to  their  manipulations,  they  are  at  a 
loss  what  more  to  do,  and  the  patient  is  usually  left  to  her 
fate,  rarely  escaping  the  consequent  septicemia.  The  Dakotas 
permit  the  patient,  if  exhausted  by  the  labor,  to  leave  the 
kneeling  posture  and  lie  down  during  this  last  stage.  Some 
of  the  tribes  belonging  to  the  great  Sioux  nation — the  Black- 
feet,  Uncapapas  and  the  lower  aud  upper  Yanktonais  — follow 
this  most  judicious  mode  of  delivering  the  afterbirth.  In 
case  that  steady  pressure  from  above  downwards  upon  the 
fundus,  and  kneading  of  the  tumor,  does  not  suffice,  the  abdo- 
men is  rudely  kneaded  with  the  clenched  fists,  in  various 
directions,  in  their  endeavor  to  push  the  placenta  out,  as  I 
gather  from  an  interesting  description  of  a  case  of  retarded 
delivery  of  the  placenta  among  the  Umpanas. 

The  Kootenais  kneel  during  labor,  and  after  expulsion  of  the 
child  continue  to  knead  the  abdomen,  exercising  the  same  pres- 
sure downward  as  when  aiding  the  descent  of  the  child,  and  in 
case  this  fails,  they  introduce  the  hand  into  the  vagina  and  re- 
move the  placenta,  giving  the  woman  one  joint  of  an  unknown 
root  to  stop  the  hemorrhage,  following  it  by  another  joint  in 
fifteen  minutes  or  half  an  hour  until  it  does  stop,  with  the  idea 


156  LABOR:    AN  ETHNOLOGICAL    STUDY. 

of  checking  the  hemorrhage  gradually.  They  let  the  patient 
bleed  to  a  certain  extent,  and  if  it  exceeds  their  idea  of  what 
she  may  well  lose,  they  give  the  root.  No  reason  is  given 
why  they  should  not  stop  the  bleeding  at  once.  This  is  one 
of  the  very  few  tribes  who  have  any  knowledge  of  the  re- 
moval of  the  placenta  by  the  introduction  of  the  hand  in 
utero.  The  Papagos  also  seem  to  remove  the  placenta  forci- 
bly, if  it  does  not  speedily  come  by  natural  means.  The 
squaws  of  several  tribes  are  delivered  in  a  squatting  posture, 
and  among  them,  also,  the  placenta  is  delivered  precisely  as 
the  child  was,  the  patient  and  her  assistants  retaining  the 
same  position,  and  the  same  pressure  and  manipulations  being 
kept  up.  This  is  true  of  the  women  of  the  Laguna-Pueblo, 
of  the  Coyotero-Apaches,  and  some  of  the  tribes  of  the 
Sioux  nation.  The  Brule,  Loafer,  Ogallala,  Wazahzah,  and 
Northern — among  these,  as  well  as  other  of  the  Sioux  tribes, 
and  the  Kiowas,  also,  a  change  of  posture  is  made.  The 
squaw  belt  is  often  used,  and  the  placenta  is  delivered  almost 
immediately  after  the  child,  by  the  gradual  tightening  of  the 
broad  leather  belt,  which  is  strapped  above  the  womb  as  soon 
as  the  child  has  appeared. 

The  women  of  the  lower  order  of  Mexicans,  who  are  also 
usually  delivered  in  the  squatting  posture,  sometimes  kneeling, 
follow  the  same  custom  as  their  Indian  neighbors,  but  of 
them  I  am  told  that  the  third  stage  of  labor  is  a  much  longer 
one.  The  midwife  busies  herself  about  the  new-born  child, 
while  the  patient  is  kept  in  her  uncomfortable  position,  kneel- 
ing or  squatting,  with  her  rear  and  lateral  assistants,  until  the 
placenta  is  expelled.  This  takes  place  seldom  in  less  than  half 
an  hour,  but  generally  within  an  hour;  if  not,  the  patient  re- 
ceives a  more  or  less  violent  shaking,  according  to  the  exigen- 
cies of  the  case,  the  rear  assistant,  with  her  arms  about  the 
patient,  actually  shaking  her  up  and  down,  and,  if  this  does 
not  answer,  as  a  last  resort,  efforts  are  made  to  provoke  vom- 
iting. A  decoction  of  some  kind,  either  laxative  or  nauseat- 
ing, is  given  the  patient  for  the  purpose  of  assisting  the  expul- 
sion of  the  placenta  ;  but  among  the  Mexicans  a  cup  of  corn 
gruel,  atole^  is  regularly  given  after  the  expulsion  of  the  child. 
Among  those  who  retain  the  semi-recumbent  position  in  which 
they  are   usually  delivered   are   the  Wacos,  Hoopas,  lower 


THE    THIRD    STAGE. 


157 


Klamath,  and  Penimonee.  This  is  a  convenience  for  the 
midwife  or  assistant,  as  she  can  also  assmne  a  more  comfort- 
able position,  and  knead  the  abdomen  to  better  purpose. 

Tlie  Indians  of  the  Pacific  coast  follow  the  same  custom, 
and  they,  as  well  as  all  other  tribes,  seem  anxious  to  attempt 
the  speedy  expulsion  of  the  placenta,  so  that  an  effort  is  always 
made  to  assist  the  uterus  in  casting  off  the  icmaining  after- 
birtli  as  soon  as  the  child  has  been  removed,  and  placed  in  a 
safe  place.  The  accoucheur  makes  gentle,  but  tolerably  firm 
traction  on  the  cord  with  one  hand,  and  with  the  other  manip- 
ulates the  abdomen  over  the  uterine  globe.  At  the  same  time, 
if  thought  necessary,  the  assistant  will  gently  press  the  abdo- 
men ;  both  hands,  with  the  distended  fingers,  being  laid  above 


Fig.  48.— Manual  expression  of  the  placenta,  Penimonee  Indians. 


the  womb.  At  times,  he  does  still  more  by  kneading,  with  a 
view  to  pressing  the  secundines  out  of  the  uterine  cavity,  but 
if  these  efforts  fail  wliile  the  patient  is  in  their  usual  obstetric 
position,  the  semi-recumbent,  she  is  raised  to  an  erect  position, 
and  then,  well  supported,  the  manipulations  of  the  uterine 
globe  are  continued,  and  a  more  firm  traction  is  made  upon 
the  cord. 

Of  the  Flat-heads  and  Pend-oreilles,  I  am  told  that  the 
placenta,  in  almost  every  case,  is  delivered  with  neither  mass- 
age nor  expression  nor  traction  on  the  cord,  nature,  unaided, 
completing  the  labor ;  very  decided  means  are,  however, 
resorted  to  in  case  delay  should  occur,  which  is  very  rare. 
Among  those  who  assume  the  semi-recuml)ent  position  are 
also  the  Utes,  Navajoes,  Apaches,  and  some  of  the  Nez-Perc^s, 


158  LABOR:    AN  ETHNOLOGICAL    STUDY. 

wlio  assist  nature  by  kneading  the  abdomen,  but  rarely  by 
actual  expression  or  traction  upon  the  cord ;  they,  however, 
expect  to  hasten  the  expulsion  by  anointing  the  abdomen 
with  greasy  unguents  or  decoctions  of  herbs. 

The  Burmese  are  among  the  very  few  people  who  adopt  a 
dorsal  decubitus  as  the  obstetric  position,  and  forcibly  expel 
the  placenta  more  by  beating  the  abdomen  than  well-directed 
manipulations,  and  in  extreme  cases,  by  sitting  or  standing 
upon  the  abdomen  and  pressing  with  the  feet  upon  the  uterine 
globe. 

The  Makahs,  of  the  Neah-Bay  agency,  retain  the  sitting 
posture  in  which  the  child  is  delivered,  but  whilst  this,  to 
them,  apparently  simple  proceeding  is  always  managed  with- 
out professional  assistance  of  any  kind,  skilled  help  is  called 
as  soon  as  the  child  is  born.  Until  then  nature  is  allowed  to 
take  its  course,  but  as  soon  as  the  child  is  expelled,  an  old 
woman,  who  makes  this  a  specialty,  is  called  to  deliver  the 
afterbirth,  which  she  does  by  pressing  and  working  the  abdo- 
men constantly  until  the  placenta  and  the  clots  are  removed. 
This  person  has  nothing  whatsoever  to  do  with  the  delivery  of 
the  child.  The  same  position  is  occupied  by  the  women  of 
the  Skokomish  agency,  and  here,  also,  the  very  best  practice 
is  followed,  the  placenta  being  allowed  to  come  away  without 
any  manual  interference  except  expression  over  the  region  of 
the  womb  and  a  slight  traction  on  the  cord. 

The  Brule  Sioux  and  Warm  Spring  Indians  retain  the  stand- 
ing posture,  in  which  the  child  is  delivered;  the  midwife, 
standing  behind  the  patient,  aids  the  naturally  rapid  expulsion 
of  the  placenta  by  pressure  on  the  fundus  with  her  hands, 
varied  by  a  kind  of  churning  manipulation. 

Intra- Abdominal  Pressure. — The  use  of  the  diaphragm  as  a 
powerful  aid  to  all  efforts  to  expel  the  contents  of  the  abdominal 
cavity  is  well-known  to  our  midwives,  and  we  know  how  fre- 
quently they  direct  their  patients  either  to  hold  their  breath  or 
to  scream,  as  the  exigencies  of  the  case  may  demand ;  but, 
fortunately,  they  do  not  resort  to  measures  quite  so  violent  as 
our  Spanish  neighbors  in  Mexico,  who  assist  the  expulsion  of 
the  placenta  by  vomiting  the  unlucky  patient.  Some  of  our 
Indian  tribes  also  lay  stress  upon  tlie  intra-abdominal  pressure, 
and  the  assistance  of  the  diaphragm  and  abdominal  muscles. 


THE    THIRD    STAGE.  159 

but  only  in  case  of  retention  or  delayed  expulsion,  and  hence  we 
shall  speak  of  this  method  farther  on.  The  Somali  of  Central 
Africa,  however,  habitually  give  the  patient  warm  mutton  suet 
to  drink  after  the  expulsion  of  the  child ;  this  has  a  laxative 
effect,  and,  with  the  contents  of  the  bowels,  those  of  the  uterus 
are  expelled. 

Traction  on  the  Cord. — Traction  upon  the  umbilical  cord 
appears  so  natural,  and  is  certainly  so  tempting  a  means  of 
removing  the  placenta,  that  it  is  much  esteemed  by  a  class  of 
meddlesome  midwives  which  abounds  in  all  civilized  countries 
to  the  detriment  of  parturient  women,  but  the  untutored  savage, 
guided  in  his  practice  by  instinct  and  observation,  is  too  shrewd 
to  seek  the  removal  of  the  retained  placenta  by  such  dangerous 
means. 

Although  it  is  customary,  among  some  of  our  Indian  tribes, 
to  make  a  certain  traction  upon  the  cord,  1  am  uniformly  told 
that  this  is  always  done  with  extreme  caution,  and  but  very . 
few  make  use  of  it  to  drag  down  the  afterbirth — a  manipula- 
tion fraught  with  so  much  danger,  and  unfortunately  so  com- 
mon among  more  intelligent  people. 

The  Crows  and  Creeks  are  usually  delivered  prone  upon 
the  stomach,  and  the  placenta  is  rapidl}^  expelled,  either  in  the 
same  posture  or  while  standing ;  in  rare  cases  it  is  delayed, 
and  then  it  is  allowed  to  remain  until  it  decomposes,  and,  re- 
markable to  say,  pyemia  rarely  follows,  probably  on  account 
of  the  naturally  strong  constitution  of  the  race.  Among 
them,  gentle  traction  upon  the  funis  is  the  only  assistance 
accorded  to  nature,  and  if  there  be  much  resistance,  it  is  at 
once  stopped,  and  the  placenta  allowed  to  remain,  in  prefer- 
ence to  attempting  its  delivery  by  stronger  traction. 

The  Rees,  Gros-Yentres,  and  Mandans  are  confined  in  a 
kneeling  posture,  in  which  the  placenta  also  is  expelled,  but  if 
it  does  not  come  away  rapidly,  with  some  little  rubbing  of  the 
belly  with  the  hands  greased  with  turtle  fat,  the  accoucheur 
pulls  gently  and  steadily  on  the  cord,  evidently  relying  some- 
what upon  this  traction  for  the  removal  of  the  placenta. 

The  worst  practice  is  that  of  the  Cheyennes  and  Arrapa- 
hoes,  who  retain  the  dorsal  decubitus  in  which  the  child  is 
expelled,  but  never  wait  for  the  expulsion  of  the  placenta  by 
the  proper  contraction  of  the  womb,  removing  it  at  once  by 


160  LABOR:    AN  ETHNOLOGICAL    STUDY. 

traction  upon  tlie  cord,  which  will  often  break  under  the  rough 
usage  to  which  it  is  subjected,  and  the  unfortr.nate  woman 
will  then  often  sutler  from  severe  hemorrhage,  due  to  the  re- 
tention of  the  placenta,  as  no  effort  is  made  to  remove  the 
organ  after  the  rupture  of  tlie  cord.  Massage  is  resorted  to, 
when  the  placenta  does  not  readily  respond  to  traction,  and  the 
accoucheur  has  judgment  enougli  not  to  pull  too  hard.  The 
Chippewas  drag  down  the  placenta  by  the  cord,  if  it  is  not 
readily  expelled  with  the  assistance  of  external  manipulation. 

Delivery  of  the  placenta  with  the  patient  in  a  diferejit  position 
from  the  one  occuj)iecl  during  the  expulsion  of  the  child. 

A  change  of  position  is  not  infrequently  made  immediately 
after  the  birth  of  the  child,  with  a  view  to  hastening  the  ex- 
pulsion of  the  after-birth.  As  this  period  of  labor  is  a  short 
one,  an  uncomfortable  position,  if  otherwise  advantageous, 
may  be  readily  assumed ;  and,  moreover,  the  muscular  effort, 
which  tlie  patient  involuntarily  undergoes  in  making  this 
change,  will  assist  the  contraction  of  the  womb.  The  change 
most  frequently  made  is  to  a  standing  posture.  Thus  the 
squaws  of  the  Cattaranguts  rise  to  their  feet  from  the  kneel- 
ing posture,  which  they  occupied  during  the  birth  of  the  child, 
with  the  idea  of  facilitating  the  expulsion  of  the  afterbirth. 
If  this  does  not  take  place  within  a  short  time,  the  attendant 
makes  traction  on  the  cord,  at  the  same  time  making  down- 
ward pressure  over  the  abdomen,  while  the  parturient  main- 
tains the  standing  posture. 

Dr.  1).  D.  Taylor,  surgeon  U.  S.  Army,  in  detailing  the 
labor  of  a  Sioux  squaw  whom  he  delivered,  seated  cross-legged 
on  the  floor,  says :  "  The  moment  I  cut  the  cord  she  jumped 
to  her  feet,  and,  standing  erect,  seized  the  squaw-belt,  a  leather 
belt  about  four  inches  wide,  which  she  buckled  over  her  hips 
and  abdomen,  drawing  it  as  tightly  as  her  strength  would  per- 
mit. During  this  time  the  hemorrhage  was  very  abundant ; 
within  a  minute,  however,  the  placenta  dropped  on  the  floor, 
the  bleeding  ceased,  the  womb  becoming  firmly  contracted, 
and  she  sat  down  on  a  stool  looking  as  if  nothing  unusual  had 
happened.  The  belt  was  removed  the  next  morning,  and  she 
remained  up  and  went  about  the  house  as  usual.     I  saw  no 


THE    THIRD    STAGE. 


161 


other  attempt  at  expression  used  but  the  application  of  the 
belt,  and  this,  I  believe,  is  universal  among  the  Sioux  for  the 
purpose  of  expelling  the  placenta  and  preventing  subsequent 
hemorrhage/'  The  Crows  and  Creeks,  as  I  have  already  men- 
tioned, who  are  often  delivered  prone  upon  the  face,  chest,  and 
abdomen,  rise  up  as  soon  as  tlie  cliild  is  expelled,  and  rest 
upon  a  stick  of  some  sort,  with  the  feet  spread  wide  apart. 
This  is  to  allow  the  blood  to  flow  very  freely,  and,  as  they 
think,  the  placenta  to  be  more  readily  and  easily  delivered. 


Fig.  49. —Use  of  the  squaw-belt,  Sioux  Indians. 

Tn  the  Uintah  Yalley  agency,  the  parturient  drinks  freely  of 
hot  water,  both  during  the  second  and  third  stages  of  labor, 
arises  to  her  feet  as  soon  as  the  child  is  expelled  in  the  usual 
obstetric  position,  kneeling,  places  a  folded  cloth  to  her  abdo- 
men, and,  leaning  forward  over  a  stout  stick,  rests  her  body 
upon  it,  tlius  exerting  considerable  pressure  over  the  hypogas- 
tric region — a  method  well  calculated  to  favor  the  expulsion  of 
the  placenta,  which  is  thus  delivered  without  any  further  assist- 
ance. Upon  the  Sandwich  Islands  they  change  the  posture  of 
the  mother  to  the  semi-erect  from  the  sitting,  in  order  to 
effect  the  speedy  removal  of  the  afterbirth,  which  they  regard 


162 


LABOR:    AN  ETHNOLOGICAL    STUDY. 


as  very  desirable  and  necessary.  The  patient  assumes  a  semi- 
erect  posture,  more  properly  squatting,  with  tlie  pelvis  thrown 
backward  and  the  knees  partly  flexed,  the  midwife  at  the  same 
time  supporting  the  child,  as  the  cord  is  not  cut  until  after 
the  delivery  of  the  placenta.  At  this  juncture  the  patient 
thrusts  her  finger  in  the  fauces  to  produce  nausea  or  vomiting, 
which  causes  a  spasmodic  expulsive  action  of  the  uterus,  re- 
sulting, not  infrequently,  in  tlie  immediate  birth  of  the  pla- 
centa and  its  membranes.     If  such  is  not  the  result,  there  is 


Fig.  50.— Placental  expression  as  practised  by  the  Indians  of  the  Uiiitah  Valley  Agency. 


more  or  less  excitement;  the  woman  retains  her  erect  position, 
is  "loomied  "  over  the  womb  and  abdomen,  a  sort  of  knead- 
ing, squeezing  operation,  generally  performed  with  the  hands 
by  the  attendant,  until  the  flooding  has  moderated  or  almost 
ceased,  when  she  is  conducted  to  a  stream  or  large  containment 
of  water,  where  she  is  washed,  secundem  artem,  re-dressed> 
and  returned  to  the  house  and  its  promiscuous  inhabitants ; 
children  and  all  being  allowed  to  witness  the  performance. 

In  Syria,  some  twenty  or  thirty  minutes'  time  is  given  for 
the  expulsion  of  the  placenta,  in  the  usual  obstetric  posture, 
in  the  chair;  but  if  this  does  not  take  place,  the  cord  is  cut, 
and  the  patient  put  to  bed  for  further  manipulation.  The 
Pawnees  change  the  position  of  the  patient  in  various  ways, 


THE    THIRD    STAGE.  163 

from  the  squatting  posture,  and  pull  upon  the  cord,  evidently 
seeking  to  obtain  expulsion  simply  by  the  muscular  contrac- 
tion resulting  from  the  motion  of  the  patient. 

MANAGEMENT  OF  THE  PLACENTA  IN  CASE  OF  RETAKDED  EXPULSION. 

We  have  already  seen  that,  as  a  rule,  the  delivery  of  the 
placenta  speedily  follows  the  expulsion  of  the  child,  nature 
being  merely  assisted  by  the  continuance  of  the  external  pres- 
sure, which  serves  to  assist  and  facilitate  the  contraction  of  the 
uterine  globe.  If  the  placenta  does  not  readily  come,  they  are 
at  a  loss  what  to  do,  and  the  patient  is  often  left  to  herself. 
Dr.  C.  M.  Harrison  writes  from  tlie  Mexican  frontier  that 
the  Indians,  and  lower  order  of  Mexicans,  seem  to  have  no 
other  method  of  extracting  the  placenta  than  by  traction  on 
the  cord,  and  that  he  has  seen  women  dead  and  dying  merely 
from  the  want  of  having  the  placenta  extracted.  The  Dakotas 
use  most  violent  means,  and  if  the  delivery  of  the  placenta  is 
at  all  retarded,  it  is  forcibly  extracted,  and  often  with  fatal 
consequences.  Other  of  the  Indian  tribes  have  more  reason- 
able ways,  and  it  is  these  which  we  will  now  consider.  The 
description  given  me  of  the  attempts  at  delivery  of  a  retained 
placenta  by  a  Mexican  midwife,  by  Surgeon  H.  R.  Tilton, 
U.  S.  Army,  embodies  many  of  the  more  violent  methods 
resorted  to.  When  called  to  the  patient,  he  found  that  she 
had  been  given  a  quantity  of  raw  beans,  between  a  pint  and  a 
quart,  as  one  remedy ;  these  were  probably  intended  to  swell, 
and  thus  drive  out  the  placenta.  This  failing,  she  had  been 
vigorously  choked,  as  another  means  of  expelling  the  after- 
birth. Finally,  she  was  placed  in  the  lap  of  her  husband,  in 
the  obstetric  position  of  that  country,  whilst  lie  squeezed  the 
abdomen  powerfully  with  his  encircling  arms.  This  last  ex- 
pedient, by  the  way,  is  a  favorite  method  among  the  Mexicans 
for  facilitating  labor,  the  contracting  uterus  being  steadily  fol- 
lowed down  by  the  arms  of  the  husband.  After  all  these 
means  had  failed,  the  after-birth  was  readily  removed  by  the 
surgeon,  upon  the  introduction  of  the  hand,  but  the  recovery 
of  the  woman  remained  doubtful,  after  the  violence  to  which 
she  had  been  subjected. 

In  the  Laguna  Pueblo,  a  tea  made  of  the  corn  blossoms,  or 


164 


LABOR:    AAT  ETHNOLOGICAL    STUDY, 


the  tops  of  the  corn,  is  given  the  patient  in  case  the  delivery 
of  tlie  placenta  is  retarded ;  hot  cloths  and  hot  stones  are  ap- 
plied, and  the  uterus  is  manipulated  externally  with  a  twisting 
motion,  which  seems,  indeed,  a  reasonable  treatment.  So 
also  among  the  Cheyennes  massage  is  resorted  to  in  protracted 
cases,  where  the  placenta  is  not  readily  removed  by  traction 
upon  the  cord ;  and  among  the  Sandwich  Islanders  the  womb 
is  "loomied"  over,  whilst  the  patient  retains  an  erect  position, 


Fig.  51. — Placental  expression,  Mexico. 


the  abdomen  being  subjected  to  a  sort  of  kneading,  squeezing 
operation,  by  the  hands  of  the  attendants,  until  the  unwilling 
placenta  is  expelled.  The  same  thing  precisely  is  done  by  the 
Indians  of  the  Pacific  coast,  who  are  usually  confined  in  a 
semi-recumbent  position,  but  in  a  retarded  third  stage  of  labor 
assume  an  erect  posture,  and  wliilst  the  attendants  are  firmly 
pressing  the  uterine  globe,  the  accoucheur  makes  a  certain 
traction  upon  tlie  cord. 

A  rather  violent  and  disagreeable  method  of  dealing  with 
the  retained  placenta  is  that  of  the  lower  order  of  Spanish 


THE    THIRD    STAGE.  165 

women  of  Mexico,  who  retain  the  kneeling  position,  in  which 
the  child  was  delivered,  and  (b-ink  a  cupful  of  soapsuds,  which 
soon  produces  vomiting  and  the  immediate  expulsion  of  the 
afterbirth.  The  Gros-Ventre  Indians  rely  upon  the  same 
plan,  but  approach  it  a  little  more  gradually ;  they  give  an 
irritant  powder  (what  it  is.  Dr.  C.  B.  Greenleaf,  surgeon 
U.  S.  Army,  who  kindly  gave  me  the  information,  could  not 
tell),  Mrst  as  a  snuff  to  excite  sneezing,  and  thus  expel  the 
placenta,  and  if  this  fails,  it  is  administered  by  the  mouth  to 
produce  vomiting,  and  these  more  forcible  muscular  contrac- 
tions seldom  fail  to  answer  the  purpose.  The  Rees  and  Man- 
dans  pull  gently  upon  the  cord,  and  rub  the  abdomen,  giving, 
in  addition,  some  remedies  which  they  also  use  when  the  ex- 
pulsion of  the  child  is  delayed.  They  have  most  faith  in  the 
berry  of  the  ground  cedar,  castorium,  or  a  button  of  the  rat- 
tlesnake's tail,  giving  castorium  in  doses  large  enough  to  pro- 
duce vomiting. 

The  method  of  the  Comanches  is  to  grasp  the  womb, 
knead  and  compress  it,  make  slight  traction  upon  the  cord,  and 
efforts  to  reach  the  placenta  with  the  hand,  in  which  the  patient 
as  well  as  the  assistant  takes  part.  The  Papagos  pursue  a 
course  which  is  certainly  peculiar  to  them,  of  producing  a 
more  steady  and,  perhaps,  not  too  violent  traction  upon  the 
cord,  by  so  attaching  it  that  the  amount  of  force  to  be  used 
is  left  to  tlie  judgment  and  the  sensations  of  the  patient ;  it 
seems  as  if  her  sense  of  pain  were  to  serve  as  a  safety  valve 
for  the  amount  of  force  to  be  expended,  and  thus  the  proper 
limit  determined  and  dangerous  consequences  avoided.  In 
the  interesting  description  given  me  by  Surgeon  Charles 
Smart,  U.  S.  Army,  who  was  called  in  a  case  in  which  the 
placenta  had  been  retained  for  three  or  four  days,  he  found 
the  attendants  in  great  alarm  for  the  safety  of  the  mother. 
The  patient  lay  on  her  side,  with  her  knees  drawn  up,  and 
every  now  and  again,  while  he  was  learning  the  particulars  of 
the  case,  she  was  directed  to  stretch  herself  out.  The  reason 
of  this  he  found  by  introducing  his  hand  for  the  purpose  of 
making  an  examination ;  a  buckskin  tliong,  about  the  size 
of  a  whipcord,  was  made  fast  to  the  cut  end  of  the  funis,  whilst 
the  other  extremity  was  discovered  hitched  around  the  great 
toe,  and  when  she  stretched  the  limb  in  bed  traction  was  made 


166  LABOR:    AN  ETHNOLOGICAL    STUDY. 

on  the  placenta.  The  doctor  found  no  adhesions  and  readily  | 
removed  the  afterbirth  upon  the  introduction  of  the  hand  into  i 
the  womb. 

Since  writing  the  above  I  learn  that  the  Japanese,  also, 
either  carefully  hold  the  projecting  end  of  the  cord  or  tie  it 
to  the  patient's  leg,  in  case  the  placenta  should  resist  the  sim- 
''pler  efforts  directed  toward  its  expulsion. 

Among  the  Flat-heads,  Pend-oreilles,  and  Kootewais,  in  | 
case  the  usually  speedy  and  natural  expulsion  of  the  pla- 
centa does  not  take  place,  the  patient  leaves  the  obstetric 
position,  upon  a  low  stool,  and  is  made  to  stand  and  walk 
about,  a  proceeding  which,  though  probably  injurious  to  the 
delicate  women  of  our  civilization,  is  harmless  and  almost 
always  successful  among  these  Indians. 

The  Indians  of  the  Misqually  agency  commonly  use  a  steam 
bath  in  the  very  rare  cases  of  retention.  A  hole  is  made  in  the 
ground  and  filled  with  hot  rocks  which  are  covered  with  leaves 
of  the  fir-tree;  water  is  then  poured  upon  them,  and  the  woman 
made  to  sit  over  this  vapor  bath  for  a  few  minutes.  This 
simple  means  seldom  fails,  and  if  it  should,  other  help  is  called 
— maybe  a  woman,  maybe  a  physician,  if  one  is  convenient. 

MANAGEMENT    OF    THE    UMBILICAL    CORD. 

The  Indian  midwives,  as  well  as  learned  obstetricians,  differ 
in  their  views  with  regard  to  the  proper  time  for  cutting  the 
funis,  but,  as  a  rule,  we  find  that  the  cord  is  not  severed  until 
labor  is  completed  and  the  secundines  are  expelled ;  this 
practice  we  find  among  the  Sandwich  Islanders  and  among 
most  of  our  Indians  ;  the  child  remaining  on  the  ground  in  front 
of  the  mother  until  the  placenta  is  delivered ;  among  the  Kio- 
was,  Comanches,  and  Wichitas,  it  is  customary,  after  the 
placenta  is  delivered,  that  the  assistant  should  take  the  cord 
between  her  fingers  and  squeeze  such  blood  as  may  remain  in 
it  back  toward  the  placenta,  and  not  until  then  the  cord  is  cut 
and  tied.  So  also  the  Blackfeet,Uncapapas, Lower  and  Upper 
Yanktou-ans  of  the  Sioux  nation  do  not  sever  the  funis  until 
the  placenta  has  been  expelled,  while  the  Flatheads  and  Koot- 
ewais, Crows  and  Creeks,  cut  the  cord  at  once,  and  I  may  here 
add  that,  as  soon  as  the  cord  is  tied  and  cut  and  the  child  is 


THE    THIRD    STAGE.  167 

removed,  the  parturient  cautiously  takes  hold  of  the  placental 
end  of  the  funis,  believing  that,  if  she  should  let  it  go,  it  would 
return  into  tlie  uterus.  The  natives  of  Syria  wait  from  twenty 
to  thirty  minutes  before  cutting  the  cord,  but  if  the  afterbirth 
is  not  expelled  by  that  time,  it  is  severed  and  the  patient  put 
to  bed. 

Some  difference  also  seems  to  exist,  and  probably  with 
reason,  for  the  methods  of  each,  as  to  the  distance  from  the 
child  at  which  the  funis  should  be  tied.  The  Wakamba,  in 
Africa,  use  threads  of  the  bast  of  the  adansonia  or  monkey- 
bread  tree,  and  tie  the  funis  tightly  two  or  three  inches  from  the 
navel,  the  Mexicans  some  three  inches.  The  Japanese  tie  the 
funis  in  two  places,  about  one  inch  apart,  close  to  the  child's 
body;  the  Comanches,  on  the  contrary,  using  only  one  liga- 
ture, tie  the  cord  about  a  foot  from  the  body  of  the  child,  and 
in  Africa  we  find  one  of  the  tribes,  the  Waswahili,  where  the 
cord  is  also  left  very  long  and  slowly  dries ;  the  navel  in  later 
years  being  often  found  the  size  of  a  fist.  The  Loango,  of 
Middle  Africa,  on  the  contrary  cut  the  cord  short  and  dry  it 
rapidly  ;  it  is  severed  at  double  the  length  of  the  first  joint  of 
the  thumb,  or  is  measured  off  to  the  knee,  then  the  child  is 
taken  to  the  fire  and  the  remnant  of  the  funis  is  steadily  pressed 
by  the  warmed  fingers  of  the  numerous  attendants  so  as  to 
hasten  its  drying,  which  is  completed  in  twenty-four  hours; 
then  the  withered  mass  is  forced  off  with  the  thumb  nail  and 
burnt  (Indiscretesaus  Loango  ;  Dr.  Pescliuel-Loesche,  Ztschrft. 
f.  Ethnolog.,  1878,  X.,  p.  29). 

The  Syrians  tie  both  sides ;  the  Catarangut  Indians  ligate  . 
only  one  end,  the  child's  end ;    so  also  the   Blackfeet,  who,  \ 
however,  take  the  precaution  to  pinch  the  protruding  placental 
end  of  the  funis  with  the  fingers,  so  as  to  prevent  oozing. 

Certain  superstitions  also  exist  in  regard  to  the  method  of 
cutting  the  funis,  a  dull  instrument  being  frequently  used,  prob- 
ably on  the  principle  of  the  modern  saw-knife,  as  bruising  and 
crushing  rather  than  cutting,  and  thus  preventing  hemorrhage. 
Some  of  the  African  tribes,  the  Wakambi  for  instance,  makes 
use  of  their  ordinary  knives ;  the  Loango,  however,  would 
deem  it  a  misfortune  to  the  new-born  babe  to  use  anything  but 
the  edge  of  the  stem  of  a  palm  leaf;  the  Papagos  of  Brazil  cut\ 
the  cord  with  a  sharp  fragment  of  a  vessel   or  a  shell.     The 


168  LABOR:    AN  ETHNOLOGICAL    STUDY. 

Hoopas,  Klamaths,  and  other  of  the  Indian  tribes  chew  off  the 
cord.  The  Klatsops,  as  we  have  seen,  pinch  one  end  with  their 
fingers.  These  various  procedures,  now  traditional  supersti- 
tions, have,  probably,  originated  in  some  thinking  mind  and  good 
reasons  have  existed  for  their  use. 

So  far  mj  observations  have  been  confined  almost  exclu- 
sively to  the  management  of  the  third  stage  of  labor  among  the 
American  Indians,  on  account  of  the  amount  of  valuable  orig- 
inal material  at  my  disposal ;  for  the  sake  of  comparison  I  will 
now  add  such  data  as  I  have  been  able  to  gather  with  regard 
to  the  treatment  customary  among  other  peoples.  Some  of 
these  facts  are  referred  to  in  other  parts  of  this  volume,  but 
the  greater  part  I  owe  to  an  instructive  paper  by  Dr.  H.  H. 
Ploss,  of  Leipzig  {Historisck-ethnographische  Notizen  zur 
Behandlung  der  NacJigeburts-P eriode). 

The  same  customs,  often  somewhat  modified,  will  be  found 
to  predominate. 

In  Old  Calabar,^  the  child,  as  soon  as  it  is  born,  is  placed 
between  the  thigh's  of  the  mother  and  remains  there  until 
the  i^lacenta  is  expelled,  however  long  this  may  be.  In  Su- 
rinam,^ the  placenta  follows  the  child  very  quickly,  and  little 
help  seems  to  be  needed.  The  Australian  woman  squats 
down  in  a  small  excavation  in  the  ground  prepared  for  that 
purpose,  and  as  soon  as  the  child  has  been  expelled  she  awaits 
the  coming  of  the  afterbirth;  the  position  is  that  as  in  de- 
fecation. It  seems  that  this  is  a  favorite  position,  and  it 
seems  reasonable,  as  many  of  the  same  muscles  come  in  play 
which  serve  in  defecation.  In  New  Caledonia,  as  well  as  up- 
on other  Oceanic  Islands,  a  number  of  old  women  assist  the 
parturient,  cut  the  cord  with  a  shell  or  splint  of  bamboo,  and 
tie  the  placental  end  of  the  navel  string  to  the  mother's  toe, 
leaving  the  expulsion  to  nature. 

A  German  physician  had  an  opportunity  to  observe  a  na- 
tive of  Sumatra,  who,  following  her  instincts,  had  the  abdo- 
men anointed  with  oil  after  the  expulsion  of  the  child,  and, 
after  some  pressing,  expelled  the  placenta  with  a  few  clots  of 

^Ilewan,  Edinburgh  Medical  Journal,  Sept.,  18G4,  page  223. 
2 mile,  Caspers  Woclicusclirift,  IS-tS,  page  87. 


THE  THIRD  STAGE.  169 

ft 

blood.  The  Tartars  of  Astrakan  are  said  to  leave  the  expul- 
sion of  the  placenta  to  nature,  while  the  Russian  women  of 
the  same  countrj^  wrap  up  the  child  as  soon  as  it  is  expelled, 
place  it  between  the  mother's  thighs  and  leave  it  there  until 
the  afterbirth  follows,  and  then  cut  the  cord. 

This  leaving  of  the  expulsion  to  nature  has  found  many 
advocates  in  the  last  centurj,  and  a  few  still  persist.  It  seems 
that  in  some  of  the  eastern  provinces,  as  in  Galicia,  the  mid- 
wives  do  not  bother  about  the  afterbirth,  and  cases  of  reten-  \ 
tion  and  putrefaction  are  common.     In  Persia  traction  upon 
the  navel  string  is  said  to  be  common.     The  same  is  said  to 
be  the  case  in  Palestine,  where,  as  Dr.  Rosen  writes,  if  the  pla- 
centa does  not  rapidly  follow  the  birth  of  the  child,  the  mid- 
wife passes  her  well  oiled  fingers  into  the  vagina  to  seize  the 
placenta.     If  it  does  not  approach   the  orifice,  she  ties  the 
cord  with  the  aid  of  a  string  to  the  patient's  toe,  and  the  I 
child  is  wrapped  up   and  kept  warm   until  the  placenta  apr.  / 
pears.     The  Chinese  follow  a  similar  method;  as  they  attach/ 
the  cord  with  a  string  to  the  patient's  hip  in  order  to  prevent! 
the  return  of  the  placenta.     Some  rest  is  then  given  the  pa- 
tient, after  which  the  placenta  is  slowly  pulled  out;  if  it  does 
not  follow,  the  hand  or  a  blunt  hook  is  introduced.     In  New 
Caledonia  the  same  method  of  tying  the  navel  string  to  the 
patient's  toe  is  followed,  as  they  think  the  stretching  of  the 
foot  will  end  the  business.  Among  all  people  where  the  man- 
agement of  this  third  stage  depends   u])oii  a.  vis  a  fronte,  & 
pulling  out  of  the  placenta,  the  manipulation  and  methods  of 
hastening  its  expulsion  are  more  severe  and  more  dangerous. 

Chinese  physicians  advise  an  expectant  method,  and  seem 
to  consider  the  remaining  of  the  placenta  as  less  harmful 
than  the  active  interference. 

Chinese  njidwives  tickle  the  fauces  with  a  feather  to  pro- 
duce vomiting,  and  then  forcibly  drag  out  the  placenta,  which 
is  the  death  of  many  women. ^ 

Inversion  and  prolapsus  are  frequent  in  Russia,  according  to 
Dr.  Kreble,  on  account  of  the  methods  of  dragging  out  the 
1  John  Kerr,  Algemeine  Medicin.  Centralzeitunf?,  xxix,  1860,  p.  54. 


1 70  LABOE  :  AN  E THNOL  0 GICAL  S T  UD Y. 

placenta;  here  the  expulsion  is  hastened  by  the  drinking  of 
warm  water.  In  France  the  placenta  is  frequently  dragged 
out  by  midwives. 

The  customs  in  Germany  are  less  harmful,  but  often  foolish 
enough.  In  the  Palatinate,  midwives  urge  the  patient  to 
cougli  or  breathe  into  the  hand;  others  rub  the  abdomen  after 
pouring  a  few  drops  of  spirits  upon  it.  In  Suavia  it  is  be- 
lieved that  the  broth  of  three  crawfish  well  mashed  up  will 
expel  the  afterbirth.^ 

In  the  Bavarian  Palatinate,  the  patient  is  urged  to  stand  up 
in  case  of  tardy  expulsion  of  the  placenta,  take  in  hand  her 
husband's  walking  stick,  put  his  hat  upon  her  head,  and  then 
she  is  again  put  to  bed,  almost  like  the  trotting  about  of  the 
Indian  women  to  expel  the  placenta,  but  not  quite  as  effective. 

Dr.  Damianius  Georgin  says  that  expert  midwives  in 
Greece  express  the  afterbirth  by  pressure  upon  the  abdomen, 
at  the  same  time  nausea  is  induced  by  placing  a  finger,  or  the 
braided  hair  of  the  patient,  into  her  mouth.  She  is  also  in- 
duced to  blow  into  an  empty  bottle.  Others  have  seen  ^  the 
Greek  mother  raised  by  her  assistant  several  times  in  suc- 
cession over  a  trij^od,  which  serves  as  an  obstetric  chair,  and 
suddenly  dropped  down  upon  it,  continuing  these  shocks  until 
the  placenta  is  expelled.  The  informant  states  that  this  pro- 
ceeding is  quite  harmless.  In  Jaffa,  upon  the  coast  of  the 
Mediterranean,  Dr.  Tobler  says  that  after  the  parturient  has 
received  a  swallow  of  brandy  the  midwife  forces  out  the  pla- 
centa by  a  firm  pressure  upon  the  navel. 

"Whatever  individual  differences  may  exist,the  various  tribes 
of  North  American  Indians  demonstrate  most  of  these  meth- 
ods, but  as  a  rule  are  more  practical. 

A  rather  surprising  conclusion  is  forced  upon  us  by  the 
study  of  these  various  methods  of  treatment  resorted  to  in  the 
third  stage  of  labor  :  the  untutored,  simple-minded  savage, 
although  crude  in  the  methods  he  pursues,  obeys  a  correct, 
even  if  we  should  term  it  an  animal,  instinct,  and  approxi- 
mates more  closely  to  the  teachings  of  the  science  of  to-day — / 

^Dr.  Buck,  Meclicin.  Volksglauben,  Ravensburg,  1865,  page  346  . 
2Moreau,  Naturgeschichte  Des  Weibes,  1810,  2ad  volume,  page  198* 


THE  TJIIIiD  STAGE.  171 

liis  practice  resembles  that  of  civilization  more  closely — than 
does  that  of  the  semi-civilized,  or  of  the  ignorant  of  the 
enlightened  communities  of  the  present. 

Instinct  has  taught  these  peoples  the  necessity  of  expelling 
the  placenta,  and  they  attain  this  object  by  the  correct  means, 
by  a  vis  a  teo'go,  by  expression — the  Makali  Indians  even 
leaving  this  important  duty  to  a  specially  skilled  person. 

Among  peoples  of  a  certain  civilization  a  more  harmful 
method  is  resorted  to  :  it  is  among  the  Chinese,  Persians, 
the  common  people  of  Russia,  and  such,  that  we  find  it 
customary  to  drag  out  the  after-birth  by  the  funis — whilst 
the  more  ignorant  of  the  midwives  of  our  great  cities  either 
follow  the  same  pernicious  habit  or  do  worse  (like  those  of 
Galicia  and  such  border  provinces),  leave  it  in  altogether, 
if  nature,  or  their  own  dangerous  traction,  does  not  readily 
produce  it. 

The  same  class  of  peojDle,  even  when  pursuing  correct 
methods,  appear  less  reasonable,  more  brutal,  than  their  I 
more  primitive  brethren.  Thus  the  Arabs,  at  times  when 
impatient  at  the  tardy  progress  of  labor,  suspend  the  par- 
turient by  the  arms  from  one  of  the  tent  poles,  to  constrict 
the  abdomen  so  as  to  force  the  foetus  down  upon  the  peri- 
neum, whatever  be  the  position.  Others  place  a  plank,  or 
other  large  flat  piece  of  wood,  upon  the  belly  of  the  mother, 
and  place  upon  it  a  sufficient  number  of  women  to  achieve 
the  pressure  necessary  to  expel  the  child  :  a  small  portable 
mill  used  for  grinding  barley  may  serve  the  same  purpose. 
Should  the  presentation  seem  at  fault,  the  patient  is  held  up 
by  the  feet  and  shaken,  or  rolled  over  and  over  on  the  ground. 

It  is  unquestionably  to  these  rough  means,  more  particularly 
traction  upon  the  funis,  that  the  women  of  these  peoples  are 
indebted  for  the  existence  and  even  the  frequence  of  prolapse, 
the  one  uterine  disease  to  which  they  are  most  subject.  Al- 
though other  uterine  diseases  undoubtedly  exist,  they  are  not 
so  apparent  to  the  observer,  perhaps  not  even  known  to  the 
sufferer  herself,  whilst  prolapse  above  all  other  disturbances 
makes  itself  known  ;  still  it  does  not  aftect  the  nervous  and 
physical  organization  of  these  stronger  and  less  delicately 
constituted  women  as  it  does  that  of  the  ladies  reared  amid 
luxuries  and  excitements  in  the  whirl  of  our  civilization. 


172  LABOR:  AN  ETHNOLOGICAL  STUDY. 

These  accidents  are  probably  more  common  upon  the  bor- 
ders of  civilization  than  among:  savaares. 

A  partial  civilization  seems  destructive  to  the  natural  and 
usually  correct  instinct  of  man,  and  in  the  relative  methods 
of  diiferent  peoples  in  managing  this  important  stage  of 
labor  we  find  a  striking  expression  of  this  fact. 

PECULIAK    SUPERSTITIONS    AND    CUSTOMS. 

The  Sandwich  Islanders,  like  many  of  our  Indians,  accus- 
tomed to  the  speedy  expulsion  of  the  afterbirth,  are  in  great 
alarm  if  this  does  not  occur,  and  think  that  a  rapid  delivery  is 
all  important;  in  case  their  simple  means  do  not  succeed,  they 
do  not  seem  to  worry  much  about  the  patient ;  the  Menemonee 
and  others  leaving  her  often  in  the  same  position  for  days, 
whilst  the  Crows  and  Creeks  and  allied  tribes,  and  the  Mexi- 
cans also,  cease  to  bother  about  her,  leaving  the  placenta  until 
it  sloughs  away,  or  the  patient  succumbs  to  the  consequent  pye- 
mia. The  African  negroes,  either  on  account  of  ignorance  or 
superstition,  rarely  make  any  attempt  at  artificial  removal  of 
the  retained  afterbirth.  Among  all  these  savage  people,  a  cer- 
tain belief  seems  to  exist  that,  i  f  nature,  aided  by  their  simple 
and  rational  means  of  external  expression,  does  not  speedily 
expel  the  placenta,  it  must  not  be  interfered  with  and  they  turn 
away  from  the  unfortunate  sufferer;  should  the  cord  tear  in 
their  efforts  at  traction,  which  fortunately  are,  as  a  rule,  gentle, 
they  give  up  the  patient ;  hence  we  see  with  what  care  the 
Kootewai  squaw  seizes  the  placental  end  of  the  cord  as  soon  as 
it  is  cut  in  order  that  it  may  not  escape  back  into  the  womb; 
it  is  possible  that  some  such  superstition,  "rather  than  obstetric 
knowledge,  should  cause  the  Indian  midwife  to  make  but  gentle 
traction  on  the  cord,  and  induce  her  to  rely  mainly  upon  ex- 
ternal pressure,  either  by  belt  or  hand,  or  even  such  as  may  be 
caused  by  the  efforts  at  vomiting ;  possibly  it  may  have  been 
the  teaching  of  some  shrewd  law-giver,  but  there  is  certainly 
some  fear  which  prevents  the  women  of  savage  tribes  from 
making  that  dangerous  traction  upon  the  navel  string  which  is 
so  common  among  their  white  sisters;  it  is  truly  unfortunate 
that  no  such  superstitious  fear  governs  the  civilized  midwife. 

A  peculiar  trait  is  also  developed  among  many  of  these  peo- 
ple which  we  are  familiar  with  in  the  superstitions  of  some  of 


THE    THIRD    STAGE. 


173 


our  typical  old  women,  who  are  often  grieved  that  they  are  not 
permitted  to  follow  their  inclinations  and  do  as  their  feelings 
and  tlieir  belief  dictate.  The  Comanches  and  other  nations 
have  a  way  of  secretly  and  mysteriously  disposing  of  the  after- 
birth, so  also  the  Loango  and  many  of  tlieir  African  sisters ;  it 
is  usually  buried,  as  is  customary  among  the  Japanese;  but  I 
hardly  believe  it  is  quite  as  effective  as  that  of  some  of  the^ 
natives  of  Brazil,  who,  if  it  can  be  done  secretly,  eat  theorga: 
which  has  been  recently  expelled  in  a  solitary  labor.  Ifob 
[served,  they  burn  or  bury  it. 


\ 


\ 


Fig.  52  — ^Vessels  in  which  tlie  placenta  is  buried,  Japan. 

A  peculiar  superstition  is  that  of  the  Loango,  who  hasten  1 
the  drying  of  the  navel,  force  it  off  within  twenty-four  hours,  / 
and  burn  it,  believing  that  the  child  would  fall  into  evil  ways  | 
if  the  remnant  of  the  funis  should  become  food  for  the  rats,  | 
and  as  long  as  the  navel  is  still  on  the  child,  no  male  being,  notl 
even  the  father,  is  admitted  to  the  presence  of  the  new-born. 


CONCLUSIONS. 


The  same  doubts  as  to  the  proper  management  of  the  third 
stage  of  labor  which  have  annoyed  our  obstetricians  seem  to 
have  arisen  in  the  savage  mind.  "We  find  various  customs  ex- 
isting among  the  different  tribes  and  people,  and,  right  or  wrong, 
they  cling  to  them  with  the  pertinacity  of  the  modern  writer, 
well  satisfied  with  the  correctness  of  his  own  view.  We  find 
the  same  methods  and  the  same  errors,  an  occasional  yielding 
to  the  same  temptations  which  beset  the  midwife  of  our  ad- 
vanced civilization,  but  in  the  main  a  correct  practice  predomi- 
nates, and  the  untutored  savage,  guided  by  instinct  and  obser- 
vation, pursues  the  very  course  which  is  now  considered  the 
most  advantageous  and  scientific  among  our  leading  obstetri- 


cians. 


174  LABOR:    AN  ETHNOLOGICAL    STUDY. 

I  cannot  refrain  from  quoting  some  points  from  the  excel- 
lent remarks  of  Playfair  upon  the  management  of  the  third 
stage  of  labor  in  order  to  show  how  well  his  teachings  are 
borne  out  by  the  instinctive  practice  of  the  savage.  He  says  : 
"There  is  unquestionably  no  period  of  labor  where  skilled 
management  is  more  important,  and  none  in  which  mistakes 
are  more  frequently  made.  .  .  .  The  general  practice  as  to  the 
management  of  this  stage  is  opposed  to  the  natural  mechanism 
of  placental  expulsion,  and  is  far  from  being  well  adapted  to 
secure  the  important  advantages  which  we  ought  to  have  in 
view."  The  objections  he  makes  to  the  ordinary  practice  are : 
"  That  it  inculcates  the  common  error  of  relying  on  the  binder 
as  a  means  of  promoting  uterine  contraction,  advising  its  ap- 
plication before  the  expulsion  of  the  placenta ;  that  it  teaches 
that  traction  on  the  cord  should  be  used  as  a  means  of  with- 
drawing the  placenta,  whereas  the  uterus  itself  should  be  made 
to  expel  the  afterbirth.  This  may  seem  an  exaggerated  state- 
ment to  those  who  have  accustomed  themselves  to  resort  to  the 
method  of  pulling  on  the  placenta,  but  I  feel  confident  that  all 
who  have  learned  the  method  of  expression  of  the  placenta 
would  certify  to  its  accuracy.  The  cardinal  point  to  bear  in 
mind  is  that  the  placenta  should  be  expelled  from  the  uterus 
by  a  ms  a  tergo,  not  drawn  out  by  a  vis  a  fronte.  .  .  .  The 
distinct  enunciation  of  the  doctrine  that  the  placenta  should  be 
pressed  and  not  drawn  out  of  the  uterus  we  owe  to  Crede  and 
other  German  writers,  but  it  is  only  of  late  years  that  this  prac- 
tice has  become  at  all  common.  Those  who  have  not  seen 
placental  expression  produced,  find  it  difficult  to  understand 
that,  in  the  great  majority  of  cases,  tlie  uterus  may  be  made  ta 
expel  the  placenta  out  of  the  vagina,  but  such  is  unquestiona- 
bly the  fact.''  Is  this  not  the  practice  most  commonly  followed 
among  our  Indian  tribes  ?  And  is  not,  in  consequence  of  this 
method  of  treatment,  the  placenta,  as  a  rule,  rapidly  expelled, 
and  its  retention  a  matter  of  very  rare  occurrence  ? 

As  a  rule  the  patient  retains  the  position  in  which  the  child 
is  expelled,  usually  one  most  favorable  for  the  use  of  the  abdom- 
inal muscles,  kneeling  or  squatting.  Steady  pressure  is  kept  up 
upon  the  contracting  uterine  globe,  and  if  its  contractions  cease, 
they  are  stimulated  by  massage,  by  a  kneading,  churning  of  the 
tumor,  and  aided  h^  slight  traction  on  the  cord,  the  placenta  is 


THE    THIRD    STAGE.  175 

expelled.  Moreover,  we  have  seen  that  the  Makah  Indians,  of 
the  Neah  Bay  agency,  are  the  only  people  who  make  a  spe- 
cialty of  the  third  stage  of  labor;  they  requh-e  no  assistance  in 
the  delivery  of  the  child,  but  after  it  has  been  expelled  an  ex- 
perienced woman  comes  to  assist  in  the  delivery  of  the  placenta 
by  expert  manipulations  of  the  abdomen  with  her  hands.  The 
North  American  Indians  and  the  African  negroes,  undoubtedly 
other  tribes  also,  have  for  ages  followed  a  practice  so  perfect 
that  only  within  the  last  few  years  the  most  alert  of  our  ob- 
stetricians are  in  a  position  to  compare  with  them ;  within  the 
last  decade,  of  this  advanced  age,  constant  scientific  research 
has  finally  placed  us  upon  a  level  with  our  less  favored  breth- 
ren. 


CHAPTER  lY. 


MASSAGE  AND  EXPRESSION. 


Among  the  latest  and  most  important  advances  in  obstetric 
practice  is  the  adaptation  of  external  manipulations  to  mid- 
wifery:  massage  and  compression  of  the  uterine  globe,  for  the 
purpose  of  exciting  muscular  activity  and  mechanically  forcing 
out  the  contents  of  the  cavity.  This  is  of  the  utmost  import- 
ance in  checking  hemorrhage  from  a  relaxed  womb,  in  the  ex- 
pression of  a  retarded  placenta  (Crede's  method)  or  an  after- 
coming  head,  and  in  the  rectification  of  malpositions  (Wright's 
or  Braxton  Hicks'  combined  version). 

Although  these  are  recent  and  valued  additions,  so  recent  that 
they  are  not  as  yet  practised  by  any  but  the  more  advanced 
obstetricians,  they  are  the  most  natural,  the  simplest,  and 
oldest  helps  in  midwifery,  in  use  among  all  primitive  people 
and  at  all  times,  from  the  day  of  the  ancient  Hebrews  and 
Arabs  to  that  of  the  North  American  Indians. 

Although  constantly  practised  by  primitive  people  for  thou- 
sands of  years,  these  methods  have  been  recently  rediscovered 
by  learned  men,  clothed  in  scientific  principle,  and  given  to  the 
world  as  new. 

Before  entering  upon  the  subject  proper  of  this  paper,  I  will 
briefly  outline  the  history  of  massage,  which,  as  an  alleviant  of 
human  suffering,  is  intimately  connected  with  the  history  of 
medicine  in  its  earliest  days ;  almost  equally  venerable  is  the 
history  of  this  art  as  applied  to  midwifery,  and  this  leads  directly 
to  tlie  subject  in  hand,  external  manipulations  in  the  obstetric 
practice  of  primitive  people.  I  will  classify  the  various  kinds 
of  massage  and  expression  and  define  their  uses,  closing  with 
a  comparison  of  the  natural  and  scientific,  and  of  the  develop- 
ment of  external  manipulation  in  modern  obstetrics. 


MASSAGE   AXD   EXPRESSION.  177 

A.        HISTOKY    OF    MASSAGE. 

Of  all  therapeutic  agents  now  in  use,  not  one  has  been  so 
uniformly  and  so  consistently  resorted  to,  and  so  successfully 
practised  at  all  times,  as  massage  :  its  history  leads  us  back  into 
the  darkness  of  the  most  remote  ages.  Homer,  in  his  Odyssey, 
already  tells  us  how  beautiful  women  rubbed  and  kneaded  the 
anointed  limbs  of  battle-worn  heroes ;  this  was  to  strengthen 
and  rejuvenate  the  tired  body,  to  give  tone  to  the  muscular  sys- 
tem. 

The  oldest  historians  and  physicians,  poets  and  travellers, 
speak  of  massage  and  give  very  accurate  descriptions,  and 
modern  travellers  tell  us  of  its  use  all  over  the  globe  ;  eastern 
travellers  especially  tell  us  of  tlie  luxury  of  massage  in  combi- 
nation with  the  bath  after  wearisome  exertion  or  labor. 

In  Rome  we  often  hear  of  massage  .  Martial  so  speaks  of  it, 
slaves  rulibed  and  anointed  bathers  in  the  public  baths  under 
Nero,  Domitian,  and  Trajan. 

Thus  it  served  to  strengthen  muscle  and  nerve,  but  how 
much  more  evident  that  it  should  be  resorted  to  for  the  pur- 
pose of  alleviating  pain  :  we  instinctively  place  our  hands  upon 
a  spot  which  pains,  and  by  pressure  seek  to  relieve  it. 

In  acute  diseases,  Hippocrates  advises  detersive  kneading,  the 
douche,  and  the  anointing  of  the  body ;  those  procedures 
which,  combined,  form  part  of  the  bath  as  prescribed  for  thera- 
peutic purposes.  In  treating  of  the  diseases  of  the  joints,  the 
brilliant  Sage  of  Cos  gives  utterance  to  these  memorable 
words :  "  the  physician  should  be  well  versed  in  many  arts,  and 
among  others,  in  that  of  massage ;  massage  will  strengthen 
the  relaxed  ligaments  of  a  joint,  and  relax  those  which  are  too 
rigid."  The  father  of  medicine  knew  that  by  well-directed 
manipulations  the  ligaments  could  be  strengthened,  could  be 
rendered  pliable,  and  movement  thus  restored.  Herodotus 
also  gives  careful  directions  as  to  this  method  of  treating  such 
disturbances. 

In  China  and  India,  massage  has  been  known  since  ancient 
times.  The  Chinese  knead  or  rub  down  the  entire  body  with 
their  hands  and  exercise  a  gentle  pressure  on  all  the  joints, 
together  with  a  certain  traction  which  is  followed  by  a  distinct 
noise,  as  is  sometimes  made  by  persons  playfully  distending  the 


178  LABOR:    AN  ETHNOLOGICAL    STUDY. 

joints  of  the  fingers.  Masseurs  wander  about  the  streets  and 
cry  out,  lauding  their  talents.  The  Chinese  themselves  brought 
this  art  from  India ;  that  ancient  Indian  work  the  Artharva- 
veda,  discovered  towards  the  end  of  the  last  century  by  Sir 
William  Jones,  contains  a  part  devoted  to  medicine — the  Ayur- 
veda ;  in  this  every  one  who  looks  for  perfect  health  is  advised 
to  rise  early,  rinse  his  mouth,  and  then  undergo  a  process  of 
shatapooing  or  massage.  Upon  the  Pacific  Islands,  also,  mas- 
sage is  well  known,  as  we  learn  from  the  writings  of  Cook  and 
Captain  Wallis.  The  practice  of  kneading  the  body  with  the 
hands  was  imported  into  Europe  by  the  crusaders  from  Syria 
and  Palestine,  together  with  the  use  of  the  warm  bath.  Un- 
fortunately the  art  soon  fell  into  the  hands  of  quacks,  but  it 
was  again  brought  within  the  sphere  of  medicine  proper  by 
Fabricius  ab  Aquapendente,  the  scholar  of  Fallopia,  who  util- 
ized it,  especially  for  affections  of  the  joints,  such  as  anchylosis 
and  others.  At  the  same  period,  combined  active  anTi  passive 
motion  was  advocated  by  Mercurialis,  Paracelsus,  and  Prosper 
Alpini,  who  highly  praises  flexion  and  massage  in  his  work,  De 
Medicina  ^gyptiorum,  Yenice,  1591,  and  says  that  in  Egypt 
massage  was  so  popular  that  no  one  could  leave  a  bath  without 
imdergoing  the  process.  The  advocates  of  the  art  in  the  last 
century  were  Hoffman  and  Tissot. 

During  the  first  years  of  this  century  the  translation  of  the 
book  of  Cong-Fou,  of  the  Bonzae  by  Tao-Sse,  by  the  mission- 
aries Hue  and  Amiot,  created  a  great  sensation ;  and  this  seems 
to  have  formed  the  basis  of  Peter  Ling's  Swedish  gymnastics 
as  proven  by  Dally  and  Estradere,  although  not  in  any  way 
mentioned  by  Ling  himself.  Still  Ling  and  his  successor 
Branting  did  much  good.  In  the  northern  countries,  in  Russia, 
Prussia,  in  Denmark,  and  especially  in  Sweden,  the  Kinesi- 
therapie,  or  treatment  by  massage,  is  highly  esteemed ;  and 
the  names  of  Ling  and  Meding  are  greatly  honored  in  connec- 
tion with  this  method.  The  most  illustrious  practitioners  of 
the  day  throughout  Europe  are  beginning  to  resort  to  it  in 
various  affections.  Among  them  I  will  mention  especially  the 
names  of  Blache,  See,  Koger,  Guersant,  Gosselin,  Recamier, 
Sarlandier,  Metzger,  and  above  all  Nelaton  and  Trousseau,  and 
in  obstetrics,  Kristeller,  Crede,  and  Martin. 

The  numeroxis  manipulations  practised  in  massage  will  be 
best  understood  if  divided  into  four  classes. 


MASSAGE  AND  EXPRESSION.  179 

First,  a  gentle  rubbing  (cffleurage,  friction  douce).  An  easy 
gliding  of  the  palmar  aspect  of  tlie  hand  and  fingers  over  the 
parts.  The  maximum  of  pressure  hereby  exercised  ought 
never  to  be  greater  than  the  weight  of  the  gliding  hand. 

Second,  pressure  (pression,  friction  forte,  massage).  A  firm 
intermittent  compression  of  the  muscles  and  their  coverings  by 
the  hands  or  fingers.  The  force  used  is  measured  only  by  the 
strength-  of  the  masseur. 

Third,  kneading  (petrissage,  malaxation).  A  methodical  pres- 
sure exercised  upon  the  muscles  with  the  entire  hand  or  fist  in 
a  perpendicular  direction,  best  compared  to  the  kneading  of 
dough. 

Fourth,  functional  movements  (mouvements,  function). 
Variable  attitudes  and  motions  undertaken  by  the  patient  with 
the  assistance  of  tlie  masseur  upon  various  movable  parts  of 
the  body,  sucli  as  the  sufferer  had  not  been  able  to  freely  prac- 
tise alone  :  supination  and  rotation,  for  instance. 

The  physiological  effects  are  readily  seen.  The  circulation  is 
improved,  absorption  is  furthered,  pain  is  eased,  the  nerves  are 
strengthened,  the  nervous  system  is  especially  quieted,  and  the 
physiological  activity  of  the  body  increased  without  cost  of 
fuel — muscular  or  nervous  exertion — to  the  patient.  There  is 
a  probability  of  a  greatly  stimulated  idio-muscular  contractility  ; 
and  it  seems  as  if  massage  had  an  effect  similar  to  electricity 
upon  the  muscles.  The  contractions  aroused  by  massage  are  a 
great  factor  in  the  process  of  absorption  generated  by  it.  The 
importance  of  massage  in  obstetric  practice  is  at  once  evident. 
Its  soothing,  nerve-quieting  influence  allays  the  excitement  of 
the  patient ;  the  muscles  are  stimulated  to  increased  activity ; 
and  these  abdominal  manipulations  will  serve  a  most  excellent 
purpose  in  uterine  inertia.  They  are  absolutely  harmless, 
uterine  activity  is  increased,  the  expression  of  the  child  hasten- 
ed, and,  after  it  is  delivered,  tlie  uterine  contraction  furthered, 
and  in  case  of  atony,  that  is  overcome  and  hemorrhage  checked ; 
but  pressure  upon  the  fundus,  the  direct  ms  a  tergo,  is,  above 
all  others,  one  of  the  most  important  factors  in  obstetric  prac- 
tice, and,  by  reason  of  its  simplicity,  within  reach  of  every 
one.  Recently  rediscovered  by  scientific  obstetricians,  primi- 
tive people,  thrown  upon  their  own  resources,  have  practised 
these  methods  at  all  times. 


180  LABOR:    AN  ETHNOLOGICAL    STUDY. 

B.    HISTOKY  OF  EXTERNAL  MANIPULATIONS  IN  OBSTETRIC  PRACTICE. 

It  is  evident,  then,  that  external  manipulations — massage  and 
expression — should  have  played  an  important  part  in  the  history 
of  midwifery  among  primitive  people  at  all  times.  First  of  all, 
it  was  their  only  help  ;  the  only  way  in  which  they  could  force 
labor  was  the  expression  of  the  unwilling  fetus  from  the  womb. 
The  vis  a  tergo  was  their  only  resort ;  and  secondly,  if  properly 
applied,  the  methods  are  unexcelled  and  correct,  both  upon 
mechanical  and  physiological  principles.  I  have  in  my  former 
writings  minutely  described  the  obstetric  practice  of  people, 
savage  and  civilized,  in  all  ages,  so  that  I  need  not  here  dwell 
at  length  upon  the  history  of  these  manipulations. 

There  is  hardly  a  people,  ancient  or  modern,  that  do  not  in 
some  way  resort  to  massage  and  expression  in  labor,  even  if  it 
be  a  natural  and  easy  one.  An  obstacle  or  irregularity  of  anyj 
kind  they  always  sought  to  overcome  by  these  methods.  Hip- 
pocrates, in  his  writings,  says:  "  If  you  put  a  fruit-stone  into 
a  narrow-neck  flask,  you  may  find  it  impossiljle  to  bring  it  out 
crosswise;  and  even  so  it  is  with  a  child  when  it  lies  across 
the  mouth  of  the  womb."  In  the  case  of  plethoric  young 
women,  venesection  was  performed  often  without  effect.  Ster- 
nutatories were  given,  and  the  nose  held  fast  when  they  began 
to  take  effect.  If  this  did  not  suffice,  a  still  rougher  mode  of 
practice  w^as  adopted :  the  patient  was  laid  on  her  back  in  bed, 
while  the  shoulders  and  upper  part  of  the  body  were  bound 
fast,  and  the  end  of  the  bed  next  her  head  was  then  raised 
and  allowed  to  fall  with  a  jerk,  which  was  supposed  to  aid  in 
the  expulsion.  Or  four  women  seized  each  an  arm  or  a  leg, 
and  thus  jerked  the  patient  up  and  down  as  she  lay  in  bed. 
If  a  malposition  existed,  this  same  succussion  was  used  with 
the  feet  high,  so  as  to  shake  the  cliild  into  the  roomy  portions 
of  the  womb. 

In  Greece,  when  a  woman  was  in  labor,  she  seated  herself 
upon  a  tripod,  the  nurse  seized  her  from  behind  around  the 
middle  of  the  body,  and  rubbed  and  pressed  upon  the  abdo- 
men witli  both  hands.  The  ancient  Ar!il)ian  physicians, 
among  them  Rhazes,  recommend  massage,  firm  rubbing  of  the 
abdomen  in  childbirth ;  and  even  now  all  the  Arab  tril)e8  of 
Caucasian  origin,  on  tlic  banks  of  the  Caspian  Sea,  have 
nurses  to  massaire  the  abdomen  and  the  lumbar  reo'ion.     Com- 


MASSAGE  AND  EXPRESSION.  jg^ 

mon  as  the  practice  is  in  Asia,  resorted  to  in  all  ages  for  va- 
rious diseases,  it  was  equally  used  in  labor  cases  for  tlie  double 
purpose  of  increasing  the  force  of  the  uterine  contractions, 
and  of  causing  the  expulsion  of  the  ovum  by  pressure. 

Modern  means  of  communication,  as  well  as  medical  schools, 
are  rapidly  doing  away  with  these  primitive  customs,  which 
were  frequently  practised  in  more  remote  regions  of  our  own 
States  in  the  early  parts  of  this  century.  Many  of  our 
older  physicians  tell  of  their  early  labor  cases  in  the  farm- 
houses of  Yirginia,  Ohio  or  Georgia,  where  the  patient 
was  delivered  upon  the  lap  of  her  husband,  whose  encircling 
arms  exercised  a  steady  pressure  upon  the  descending  uterus ; 
even  now  expression  is  occasionally  practised  in  this  way. 

Among   our    Indians,  at   least   such    of  them    as   are   not 
yielding  to  the   civilizing  influence  of  the  agency  physician 
or  the  army  surgeon,  massage  and  expression  are    common, 
whether  the  parturient  occupies  the  kneeling,  sitting,  recum-» 
bent,  or  semi-recumbent  position ;  malpositions  are  corrected/ 
and  labor  hastened  by  tlie  hands  of  an  assistant,  who  kneads 
the  loins  and  abdomen,  and  exercises  pressure  by  the  palm 
of  the  hands   placed  upon  the   uterine   globe.     Among   the 
natives    of    Mexico,    of    Central  and    South    America,   it  is  I 
still  common  practice.     At  the  time  of  the  Incas,  the  exit  of  I 
the  child  was  hastened  by  the  firm  compression  by  an  assist- 1 
ant's  arms,  which  closely  encircled  the  waist  of  the  sufferer. 
Among  the  Calmucks,  the  parturient  squats  down  upon  her  but- 
tocks at  the  foot  of  her  bed,  and  braces  herself  against  a  pole 
that  descends  obliquely  from  the  top  of  the  hut,  very  similar  to 
the  practice  now  in  use  among  the  Mexicans,  and  the  assistant 
clasps  her  in  her  arms,  and,  when  labor  begins,  seats  herself 
upon  the  ground,  takes  the  patient  upon  her  knees,  and  presses 
and   kneads  the    abdomen  from    above    downward.      If   the 
strength  of  the  patient  begins  to  fail,  she  is  placed  upon  two 
boxes,  and  a  strong  man,  standing  behind  her,  compresses  the 
abdomen  with  all  the  strength  of  his  arms.     Among  the  Tar- 
tars 'the   nurses  hang  the  woman   up  by  the  arms,  and  com- 
press the  abdomen  with  bandages ;  sometimes   they  place  a 
heavy  weight  on  the  abdomen. 

In  tlie  East  Indies,  they  knead  the  back  and  loins — shani- 
2)00.     In  the  seventeenth  century,  massage  was  practised  in 


182  LABOR:    AN  ETHNOLOGICAL    STUDY. 

Siam  in  difficult  labors.  Hnreaii  de  Yilleneuve  has  described 
this  practice  under  the  name  of  Cong-foii.  He  says  that  its 
object  is  to  lessen  pain,  and  explains  it  by  reflex  action.  The 
manipulation  consists  essentially  of  light  rubbing,  touching, 
delicate  pressure,  tickling,  and  friction  with  the  ends  of  the 
fingers.  In  this  the  nurse  must  be  methodical.  The  manipu- 
^lations  must  be  made  during  the  pain,  and  not  only  upon  the 
abdomen,  but  also  upon  the  perineum,  the  groins,  the  hypo- 
chondrium,  and  over  the  diaphragm.  Among  the  Japanese, 
AiTibouk  is  a  kneading  of  the  body,  with  the  object  of  expel- 
ling the  child.  They  also  have  a  practice  called  Seitaz  or  ver- 
sion, in  which,  by  external  manipulation,  they  pretend  to 
:  ectify  malpresentations. 

The  Malays  put  hot  bricks   upon   the  woman's    abdomen,    j 
;  md  press  upon  the  bricks  with  all  their  force.     The  Negritas  | 
jclasp  the  trunk  of  a  bamboo  and  press  against  it.     In  New  / 
/Caledonia,  they  use  violent  pressure  and  blows  of  the  fist  in  I 
/hard  labor.      In  Senegal,  some  one  sits  upon  the  patient's/ 
abdomen.     In  Old  Calabar,  the  woman  is  put  in  a  sitting  pos-| 
ture,  and  the  nurse  compresses  the  abdomen  with  the  hands 
anointed  with  oil.     Among  the  negroes  of  New  Guinea,  the 
parents  or  friends  of  the  woman  assist  her  by  beating  or  kicking 
her  in  the  stomach.     In  Kabylie,  no  manipulations  seem  used 
in  ordinary  labor,  but,  what  is  rare  among  other  people,  traction 
upon  the  parts  already  expelled  is  made ;  if,  however,  labor  is 
slow,  an  assistant  butts  the  patient  in  the  abdomen^  She  places 
lier  head  upon  the  pregnant  womb,  and  clasping  her  hands  be- 
hind the  patient's  back,  presses  first  upon  the  back,  then  upon 
the  abdomen  to  hasten  the  expulsion  of  the  child.     Some  of  our 
own  Indians  strap  a  pillow  of  some  kind  to  the  abdomen,  and  lie 
flat  upon  the  ground,  thus  to  express  tlie  fetus;  others  press 
the  abdomen  upon  a  staff  firmly  planted  in  the  ground  ;  but^  j 
as  I  have  already  stated,  by  far  the  most  common  methods  1 
are  massage  of  the  back,  of   the  loins,  and  abdomen,  to  in- 
crease the  uterine  contraction,   and    the    pressure    upon  the 
abdomen  by  the  encircling  arms,  or  by  the  hands  laid  upon 
the  uterine  globe  to  express  the  fetus. 


MASSAGE   A. YD   EXPRESSION.  183 

C    THE    VARIOUS    KINDS    OF    EXTERNAL    MANIPULATION MASSAGE 

AND    EXPRESSION IN    THE    OBSTETRIC     PRACTICE     OF    PRIMITIVE 

PEOPLE. 

I  will  endeavor  to  classify  the  various  forms  of  external 
manipnlations  in  use  among  primitive  people,  taking  first,  as 
tlie  most  simple,  the  different  forms  of  (I.)  Expression.  These 
are  usually  practised  by  an  assistant,  most  frequently  (1)  by^ 
the  arms  encircling  the  patient's  abdomen,  the  hands  usually 
clasped  in  front  over  the  uterine  fundus,  thus  forming  a  pow- 
erful compressor. 

(2.)  This  living  compressor  may  be  replaced  by  a  ban- 
dage, the  ends  of  which  are  in  the  hands  of  an  assistant. 

Another  method  (3)  is  to  draw  the  patient's  abdomen 
across  a  rope  or  pole,  so  as  to  force  down  the  uterine  globe. 
In  more  difficult  cases  (4),  the  patient  is  suspended  by  a  rope, 
and  the  uterus  stripped  down  by  the  weight  of  an  assistant, 
who  hangs  upon  the  abdomen  of  the  sufferer.  And  (5)  an 
equally  uncouth  method  of  expressing  the  ovum  is  by  the 
feet  of  an  assistant,  or  sympathizing  friend,  who  tramps  upon 
the  back  or  belly  of  the  patient,  or  by  a  weight  placed  upon 
the  enlarged  abdomen.  In  some  instances,  the  patient  her- 
self exerts  the  external  force  (6)  by  the  tightening  of  a  belt ; 
(7)  by  leaning  with  the  uterine  fundus  against  a  staff  firmly 
planted  in  the  ground  ;  or  (8)  by  lying  flat  upon  the  ground 
with  a  pillow  under  the  abdomen. 

II.  Massage,  or  the  shampooing  of  the  abdomen,  is  a  some 
what  more  complicated  operation  ;  in  almost  all  cases  practised 
by  an  assistant,  and  usually  in  connection  with  simple  expres- 
sion.    I  will  merely  refer  to 

III.  The  shaking  out  of  the  ovum  ;  and 

IV.  Permanent  pressure. 

I.  Expression, — Simple  expression  is  resorted  to  among 
primitive  people  in  almost  every  labor ;  it  is  the  most  rude  and 
primitive  form  of  external  manipulation,  and  at  once  suggests 
itself  as  an  aid  to  tiie  forces  of  nature  M'hen  assistance  seems 
called  for.  It  is  used  both  in  the  delivery  of  the  child  and  of 
the  placenta;  and  the  method  which  first  suggests  itself  is  the 
one  most  commonly  resorted  to. 

(1 .)  By  the  arms  of  an  assistant  encircling  the  patient^  s  dbdo- 


184  LABOR:    AN  ETHNOLOGICAL    STUDY. 

men.  That  this  has  been  so  commonly  resorted  to  at  all  times 
and  by  all  people  is  evident  when  we  remember  that  in  so  many 
cases  the  patient  is  delivered  seated  in  the  lap  of  an  assistant, 
be  it  on  a  chair,  or  stone,  or  upon  the  ground.  This  position 
was  common  in  ancient  times  and  modern ;  I  will  again  refer 
to  the  ancient  Peruvian  urn  with  the  patient  seated  in  the  lap 
of  her  husband;  the  method  is  still  in  use  upon  the  South 
American  coast,  in  Peru,  in  Chili ;  it  was  common  among  the 
ancient  Hebrews,  in  Rome,  and  in  medieval  Italy ;  also  in 
Greece,  ancient  and  modern.  We  find  it  in  Africa  and  India  ; 
rarely  among  the  American  Indians,  where  tlie  lazy  male  is 
unwilling  to  undertake  this  laborious  task  ;  here  and  there 
among  the  Scotch  and  Welsh;  in  various  of  the  backwood 
counties  of  our  own  States;  among  the  Sandwich  Islanders; 
the  Bedouins;  and  the  Kalmucks  of  Pussia. 

The  same  method  is  resorted  to  whether  the  patient  is  de- 
livered in  a  standing  posture,  as  among  some  of  our  Sioux 
tribes,  or  among  the  Crows  and  Comanches,  where  the 
patient  kneels,  the  assistant  kneeling  behind  her,  clasping  the 
abdomen  firmly  above  the  uterus,  and  keeping  up  steady 
pressure  during  the  entire  labor.  Among  the  Nez-Perces  and 
Gros- Ventres,  where  the  patient  assumes  the  squatting  posture, 
the  encircling  arms  of  the  assistant  exercise  the  same  steady 
compression.  Among  the  Kootenais  (see  Fig.  19,  Posture), 
where  the  parturient  is  upon  her  hands  and  knees,  the  same 
method  is  in  use ;  whilst  the  woman  is  on  her  knees,  the  face 
touching  the  ground,  the  hands  one  above  the  other  grasping 
a  pole  planted  in  theground,  and  the  legs  apart,  a  man  straddles 
her  across  the  buttocks,  and  with  his  hands  clasped  around  her 
waist  exercises  a  steady  pressure  on  the  abdomen,  pulling, 
however,  only  during  a  pain.  The  way  in  which  the  pressure 
is  exercised  is,  of  course,  much  the  same  among  different 
people  whatever  be  the  position  assumed. 

In  some  rare  instances,  in  the  mountainous  portions  of  Ger- 
many, the  woman  is  delivered  suspended,  in  the  arms  of  her 
husband,  wlio  seizes  her  from  behind,  and  raises  her  up  so  that 
she  is  bent  backward,  her  toes  barely  touching  the  ground.  In 
this  position,  of  course,  with  his  hands  clasped  atove  the 
uterus,  a  steady  and  very  powerful  pressure  is  exercised.  In 
other  cases,  as  among  the  Brule  Sioux,  and  among  some  of  the 


MASSAGE  AND  EXPRESSION.  JgS 

Iroquois  of  Canada,  the  patient  hangs  to  the  neck  of  an 
assistant,  who  exercises  pressure  by  forcing  his  abdomen 
Mgainst  that  of  the  patient,  his  arms  around  her  waist,  his 
hands  clasped  at  her  back.  A  similar  method  of  pressure  is 
exercised  by  the  Japanese  obstetrician  in  correcting  mal- 
position during  the  later  months  of  pregnancy.  He,  however, 
uses  his  hands  rather  to  knead  the  abdomen  than  to  compress 
the  womb,  but  very  much  in  the  same  way  as  the  Sioux 
assistant. 

In  the  case  of  a  patient  seated  in  the  lap  of  an  assistant,  the 
description  I  find  given  of  a  labor  among  the  Sandwich 
Islanders  is  characteristic:  It  is  the  duty  of  this  assistant, 
n  whose  lap  the  parturient  rests,  to  grasp  the  waist  above 
the  abdomen  in  such  a  way  that  he  or  she  can  press  down  upon 
the  uterus  and  its  contents  with  a  considerable  force,  not 
relaxing  tliis  grasp  to  allow  the  fetus  to  recede.  The  force  of 
the  pressure  is  backward  and  downward,  increased  during  the 
pains,  and  kept  up  in  a  moderate  steady  measure  during  the 
interval  to  prevent  a  loss  of  the  advantage  gained  during  each 
pain.  This  method  is  well  represented  by  an  illustration  (Fig. 
32,  Posture),  made  in  accordance  with  the  characteristic  de- 
scription of  obstetric  practice  in  the  rural  districts  of  Ohio  some 
twenty  years  ago,  given  me  by  my  friend,  Dr.  E.  B.  Stevens. 

This  is  resorted  to  among  many  of  the  Mexicans  and  half- 
breed  Mexicans  ;  among  the  Andamanese ;  among  such  of  the 
Hindoos  in  India  as  are  delivered  in  the  lap  ;  and  among  the 
Burmese,  f  In  case  that  the  patient  kneels  in  labor,  which  is 
perhaps  the  most  common  position  among  the  Indian  squaws, 
the  assistant  either  kneels  behind  the  patient,  or  stands  astride 
of  or  between  her  feet,  and  encircles  the  abdomen  with  her 
arms,  exercising  the  same  constant  pressure  as  when  other 
positions  are  assumed.  This  custom  we  find  prevalent  among 
the  yellow  races  as  well  as  the  red,  in  Kamtschatka  and 
Mongolia;  less  common  among  the  black,  in  Ethiopia,  and  also  I 
in  New  Zealand. 

(2.)  A  bandage  passed  around  the  hody  and  tightened  hy 
assistants,  supplants,  in  some  cases,  the  encircling  arms:  this 
is  not  so  much  the  usual  practice  in  ordinary  cases,  but  rather 
a  severer  measure  adopted  in  retarded  labor.  A  description  of 
tliis  method  is  found  in  the  Medical  Times  and  Gazette  for 


186 


LABOR:    AN  ETHNOLOGICAL    STUDY 


August,  1861,  describing   a  labor   at   Monterey,   California;, 
"  The  patient  was  seated  in  a  chair,  seizing  with  her  hands  a 
rope  pendent  from  the  ceiling.     A  bandage  was  placed  about 


Fig.  53.— Bandage  as  used  in  Mexico. 

her  body,  tht)  ends  of  which  were  crossed  behind,  each  of 
wliich  was  grasped  by  an  assistant,  whose  duty  it  was  to  make 
firm  traction  upon  the  sheet,  and  especially  to  draw  tightly  as 


MASSAGE   AND   EXPRESSION.  187 

the  abdomen  diminished  in  size.     They  were  particularly  in-  ^ 
structed  to  make  strong  traction  in  the  intervals  between  the  \ 
pains,  lest  tlie  abdomen  during  this  time  should  resume  the  I 
position  it  had  before  the  pain  came  on."     Similar  accounts  I  I 
I  hear  from  Mexico,  from  South  America,  from  the  north  of  \ 
India.     The  Finns,  in  difficult  cases,  when  the  cliild  will  not 
advance,  force  it  out  by  tight  compression  of  a  strap  placed 
around   the    abdomen;    the    Calmucks    likewise    follow    this 
custom. 
t     The  Klatsops  use  a  bandage  only  for  the  expression  of  the  I 
/  after-birth,  and  this  appears  to  me  to  be  a  very  reasonable  I 
I  procedure ;    a  bandage  is  placed  about  the  abdomen  of  the  \ 
^l^-p?ttient  after  the  deliveiy  of  the  child,  thus  not  only  aiding  the  I 
^^^   1  expression  of  the  placenta,  but  preventing  the  expansion  of  the  I 
j  womb ;   in  other  words,  preventing  post-partum  hemorrhage,  \ 
'  and  furthering  the  necessary  contractions.     The  Piute  Indians  ^ 
make  use  of  a  bandage  in  a  somewhat  different  way ;    they 
clasp  a  leather  girdle  around  ^the  waist  above  the  fundus  of  the 
womb,  not  so  tight-fitting  but  that  it  will  slip  up  and  down  on 
the  body ;  then,  as  the  expulsive  pains  come  on,  three,  four,  or 
more  women  push  the  girdle  down  after  the  escaping  child. 
They  regard  the  descent  of  the  child  as  voluntary  on  its  part, 
and  push  the  girdle  down  to  support  it  in  anyprogres  it  makes 
from  time  to  time,  that  it  shall  not  lose  its  foothold  and  slip 
back,  and  thereby  lose  all  the  distance  gained  by  the  effort  for 
food  and  day-light :    so  as  labor  progresses,  the  child's  foot- 
steps are  followed  up  by  this  girdle,  until  it  is  finally  expelled  ;  or, 
as  they  say,  it  has  asserted  its  freedom  and  broken  its  fast. 

(3.)  Drawing  the  abdomen  across  a  rope  or  pole.  A  peculiar 
custom,  which  we  have  not  found  elsewhere,  exists  among  the 
Winnebagos  and  Chippewas.  In  difficult  cases,  more  common 
among  the  more  civilized  Indians  who  have  half-breed  children, 
as  is  so  frequently  found  where  races  mix,  a  cross-bar  or  rope 
stretched  across  the  tent  is  always  on  hand,  as  it  gives  a  support 
to  the  patient  who  kneels  in  labor  ;  but  when  this  will  not  ad- 
vance, the  woman  is  generally  drawn  over  the  bar,  face  down- 
ward, the  upper  part  of  the  stomach  resting  upon  the  wood, 
and  several  persons,  all  women,  supporting  her  ^arms,  gently 
draw  and  push  her  over  the  bar  or  rope.  This,  I  am  told,  is 
the  only  kind  of  expression  employed  among  these  tribes ;  an 


188 


LABOR  :    AM  E  THNOL  0  GICA  L    STUDY. 


instance  of  this  kind  is  related  to  me  by  Surgeon  W.  S.  King, 
U.  S.  A.,  in  which  a  patient  was  so  drawn  over  a  rope  sus- 
pended between  two  trees. 

(4.)  Stripping  down  the  ahdomen.  This  is  only  resorted  to 
in  desperate  cases ;  but,  although  not  common,  seems  to  be  the 
last  resort  among  various  people.  I  hear  of  it  in  Siam,  among 
the  Tartars,  and  among  the  Coy otero- Apaches ;  and,  remarkably 


Fig.  54.— Management  of  difificult  labor  in  Siam. 

enough,  precisely  the  same  method  is  adopted  in  each  instance 
(see  Fig.  25,  Posture).  The  parturient  is  suspended  by  bands 
beneath  the  arms,  and  one,  sometimes  two,  of  the  attendants 
grasp  the  body  of  tlie  patient  in  their  arms,  and  strip  down 
the  womb  with  considerable  force ;  a  kind  of  "  all  pull 
together,"  as  Dr.  Reed,  Surgeon  U.  S.  A.,  expresses  it.     He 


MASSAGE  AND  EXPRESSION.  189 

says  that  this  energetic  maneuvre  generally  suffices,  as  he 
never  heard  of  a  case  that  resisted  this  method.  That  is  very 
likely,  as  the  fetus  will  find  an  outlet  somewhere,  be  it  per 
vias  natural es  or  througli  the  abdominal  walls.  The  child 
must  out.  Other  means  they  have  none;  hence,  it  is  the  best 
that  can  be  done,  although  we  should  think  that  the  mother, 
if  not  the  child  also,  must  inevitably  suffer. 

(5.)  Expression  hy  means  of  the  feet.  A  very  effective  and 
not  very  delicate  method,  pursued  by  experts  among  some  very 
primitive  people,  is,  in  difficult  cases  where  the  ordinary 
methods  have  not  answered,  to  stand  upon  the  abdomen  of  the 
patient,  with  the  heels  upon  the  thorax,  the  toes  pressing  upon 
the  uterine  fundus,  and  thus  to  express  the  child  ;  or,  as  among 
the  Negri tas  of  the  Philippine  Islands,  or  the  Waswaheli, 
among  the  Siamese  and  Burmese,  an  old  woman,  who  takes 
the  place  of  the  midwife,  places  her  left  foot  upon  the  patient's 
body,  pressing  upon  the  fuudus,  while  she  drags  doiwn  the 
baby  with  the  right  hand.  A  report  from  Siam  (Samuel  R. 
House,  M.D.,  Archives  of  Med.,  June,  1879)  states  that  a 
favorite  way  to  expedite  matters  is  to  press  with  great  force 
on  the  abdomen  and  its  contents,  shampooing  vigorously  with 
the  thumbs  and  fists,  and  even  to  stand  upon  the  poor  woman's 
body,  crowding  the  heels  upon  the  front  or  side  of  the  dis-i 
tended  uterus,  and  without  the  slightest  reference  to  or  knowl-l 
edge  of  the  condition  of  the  os  uteri.  In  Coram,  they  place 
the  patient  flat  upon  her  stomach  to  force  the  expression  of  the 
child.  The  Negritas,  also,  are  fond  of  placing  bricks  or 
stones,  but  hot,  upon  the  abdomen  of  tlie  patient  to  insure 
expression. 

In  some  few  instances,  the  parturient  practises  expression 
herself,  either  with  her  own  hands,  by  the  tightening  of  a  belt,, 
or  by  pressing  against  a  fixed  body.  I  have  seen  but  one 
statement,  and  that  is  from  the  Indians  of  the  Pacific  slope, 
that  the  parturient  uses  her  own  ban  Is  to  compress  and  press 
down  the  womb.  How  much  more  useful  than  the  senseless 
grasping  of  bed-clothes  or  assistants  by  tlie  civilized  lady  ! 

(6.)  The  belt.  The  belt,  which  is,  of  course,  the  same  as 
the  bandage,  only  that  it  can  be  used  by  the  patient  herself,  is 
resorted  to  by  some  of  the  more  primitive  of  Russian  tribes, 
and  by  some  of  our  own  Indians,  especially  the  Sioux,  and 


190  LABOR:    AN  ETHNOLOGICAL    STUDY. 

there,  more  particularly,  for  the  expression  of  the  after-birth. 
The  belt  called  the  squaw  belt,  a  broad  leather  strap  with  sev 
eral  buckles,  is  commonly  used;  after  the  delivery  of  the 
child,  as  the  patient  stands  up,  her  legs  apart,  she  herself 
draws  tight  the  belt,  and  thus  expresses  the  after-birth,  which 
readily  drops  out  by  sheer  force  of  gravity,  assisted  by  this 
forcible  vis  a  tergo. 

(7.)  Pressure  against  the  staf.  The  Indians  of  the  Uintah 
"Valley  Agency  are  delivered  in  a  kneeling  posture,  but  as  soon 
as  the  child  is  expelled,  the  patient,  who  continues  to  drink 
freely  of  hot  water,  arises  to  her  feet,  places  a  folded  cloth  on 
her  abdomen,  and  leaning  forward  over  the  stake,  some  three 
feet  in  length,  which  has  served  her  as  a  support  during  labor, 
she  raises  her  body  upon  it,  thus  exerting  considerable  pressure 
over  the  hypochondriac  region  and  favoring  the  expulsion  of 
the  placenta ;  and  it  is  thus  delivered  without  any  further 
assistance.  This  practice  also  exists  among  the  Crows,  Creeks, 
and  similar  tribes.  The  Negrita  woman,  who  is  imable  to 
allow  herself  the  assistance  of  the  medicine  man,  presses  her 
abdomen  against  a  bamboo,  in  order  in  some  measure  to 
replace  the  expression  by  the  hands  of  an  assistant.  The 
squaw  of  the  Pacific  coast,  who  walks  about  during  the  first 
day  after  confinement,  steps  about  slowly  with  a  staff,  fre- 
quently bending  the  body  forward  so  as  to  bring  the  abdomi- 
nal walls  immediately  over  the  region  of  the  uterus  against 
the  upper  end  of  the  staff,  whicli  is  protected  by  the  hands  of 
the  woman.  Thus,  the  flow  of  the  lochia  is  facilitated  and 
compression  of  the  uterus  furthered. 

(8.)  Lying  prone  upon  the  stomach  upon  a  pillow.  This 
peculiar  method,  so  far  as  I  can  learn,  is  practised  only  by  the 
Creek  Indians.  The  mother  straps  the  pillow  tightly  to  her 
chest  with  a  belt,  lies  flat  upon  her  face,  and,  as  the  labor  pro- 
ceeds, the  strap  is  buckled  tighter  and  tighter,  until  the  expul- 
sion is  accomplished,  the  pressure  being  due,  not  so  much  to 
tlie  tightening  of  the  strap  as  to  the  pressure  of  the  body  upon 
the  uterus,  the  pillow  simply  preventing  the  upward  motion  of 
the  fundus.  In  Coram,  Loango,  and  other  districts  of  Central 
Africa,  the  patient  is  also  placed  upon  the  stomach,  if  the 
labor  does  not  progress,  and  the  expulsion  of  the  child  is  has- 
tened by  tramping  upon  the  back  of  the  sufferer,  or  placing 
lieavy  weights  upon  it. 


MASSAGE   AXD   EXPRESSION: 


191 


II.  Massage.  Massage,  by  which  I  understand  a  more 
■complicated  manipuhition  of  the  abdomen — the  Shampoo  of 
the  Indies ;  the  Cong-Fou  of  the  Chinese ;  the  Ainbo\ik  of  the 
Japanese — serves  to  correct  the  position  of  the  child,  and  to 


Fig.  55.— Massage  and  expression  as  practised  in  Blexico. 

stimulate  the  contractility  of  the  uterine  muscles,  and  is  used 
wherever  external  manipulations  are  resorted  to,  almost  always 
in  connection  with  expression.  It  is  used  to  correct  malposi- 
tion, to  produce  abortion,  to  stimulate  labor  pains,  but,  above 
all,  for  the  expression  of  the  after-birth  and  the  prevention  of 


192  LABOR:    AN  ETHNOLOGICAL    STUDY. 

post-partum  hemorrhage.  These  manipulations  are  usually 
practised  very  much  in  the  same  manner  whatever  position  the 
patient  assumes ;  and  they  serve  the  same  purpose  whatever 
the  position  of  the  patient  may  be — kneeling,  squatting,  resting 
in  the  lap  of  an  assistant,  or  semi-recumbent — and  they  are 
best  illustrated  by  Fig.  55,  wliich  is  from  a  photograph  taken 
for  me  amid  great  diiSculties  by  my  scientific  friend,  Prof.  G. 
Barroeta,  of  San  Luis  Potosi,  Mexico. 

The  patient  kneels  on  the  spread  (B)  prepared  for  her ;  this 
consists  of  a  sheep- skin  (S)  covered  with  a  cotton  blanket  (C) 
and  a  zarape  (Z).  Upon  one  end  of  this  is  put  a  cushion  (H), 
upon  which  the  patient  places  her  head  when  she  assumes 
the  recumbent  posture  after  delivery.  The  position  of  the 
parturient  is  upon  her  knees,  supporting  herself  by  the  cord 
or  lasso  (L),  which  is  suspended  from  the  beam  (W).  Two 
assistants  perform  the  customary  manipulations.  The  j!;ar^er«,  i 
the  more  experienced  and  older  of  the  two  assistants,  kneels 
before  the  sufferer ;  it  is  her  business  to  manipulate  the  uterus, 
pressing  and  rubbing  the  fundus,  at  times  placing  one  hand 
on  the  vulva,  and  preparing  the  coccyx.  The  younger,  the 
tenedora,  kneels  behind  the  patient,  pressing  her  knees  upon 
her  hips,  and  clasping  the  hands  over  her  stomach,  thus  exer- 
cising pressure  by  the  encircling  arms,  whilst  the  more  expe- 
rienced partera  practises  massage.  (Dr.  Kellog.)  The  tene- 
dora  assumes  more  active  duties  in  difficult  cases,  either  in 
retarded  labor  or  retained  placenta.  She  then  raises  the 
patient  by  her  arms,  shakes  her  as  she  would  a  sack,  and  lets 
her  fall,  partially  catching  her  as  she  drops,  with  a  sliock 
and  sudden  compression  of  the  abdomen  whilst  the  parts  are 
being  kneaded.  Although  the  methods  are  very  much  the 
same  among  all  people  and  in  all  positions,  slight  differences 
are  here  and  there  observed  ;  for  instance,  among  the  Papagos, 
one  of  the  assistants  places  herself  in  a  kneeling  posture 
behind  the  patient,  with  one  knee  pressing  upon  the  lumbar 
region,  while  she  grasps  the  body  of  the  sufferer  with  both 
liands  immediately  under  the  ribs  in  front.  The  other  assist- 
ant places  herself  in  a  kneeling  position  in  front  of  the  patient, 
and  with  the  palms  of  her  hands  rubs  the  abdomen  thoroughly, 
tlie  pressure  being  constantly  exercised  downwards  from  the 
spine  of  the  ilium  to  the  pubis.     They  appreciate  the  differ- 


MASSAGE   A. YD   EXPRESSION.  I93 

ence  between  primipara  and  multipara,  and  with  tlie  former 
they  do  not  resort  to  the  same  degree  of  pressm-e  and  fric- 
tion us  in  the  multipara,  being  evidently  aware  of  the  more 
firm  tone  of  the  abdominal  muscles,  and  of  the  longer  time 
needed.     In  Africa  and  in  India,  we  find  not  unfrequently  that 
warmth  and  oil  aid  in  this  process,  as  among  the  Gros-Yen- 
tres,  where  the  assistant  greases  her  hands  with  turtle  fat  and 
warms  them  over  the  hot  embers,  and  quickly  applying  the 
heated  hands  to  the  patient's  abdomen,  rubs  and  presses  it  down- 
ward   and  backward.     These   manipulations    are,  of   course, 
more  readily  practised  with  the  patient  in  a  kneeling  or  squat- 
ting position,  and  especially  when  seated  semi-recumbent  in 
the  lap  of  an  assistant,  whose  encircling  arms  afford  the  means 
of  compression.     But  with  the  necessary  variations,  it  is  the 
same  whatever  position  the  patient  assumes.     For  instance, 
among  the  Hoopa,  Klamath,  or  Penemone  Indians,  the  patient 
lies  down  in  a  serai-recumbent  position,  whilst  an  assistant 
kneels  at  either  side,  rubbing  and  pressing  the  abdomen.     So, 
also,  among  the  Siamese,  where  the  patient  is  on  her  back,  a 
woman  takes  position  on  either  side,  and  they  begin  by  forci- 
bly pressing  the  abdomen  backward  and  down  for  three  to  five 
hours,  and,  if  then  they  fail  to  expel  the  fetus,  one  tramps 
upon  the  abdomen,  and,  as  we  have  learned,  if  this  does  not 
succeed,  the  more  forcible  method  of  suspension  is  resorted  to. 
Instead  of  the  hands,  the  thumbs  and  fists  are  used  by  some. 
For  instance,  as  in  Siam,  where  they  shampoo  the  abdomen 
vigorously  in  this  method,  stroking  and  pressing  it  downward 
at  the  same  time.     Among  some  people  I  find  no  reference  to 
the  use  of  massage,  but  have  considered  this  more  as  an  omis- 
sion upon  the  part  of  my  informants.     For  instance,  among 
the    Chippewas  and  Blackfeet,  lower  and  upper  Yanktonais, 
nothing  is  said  of  the  use  of  massage  by  my  correspondent. 
So,  also,  among  the  Santees  and  Dakotas,  the  Cherokees,  Choc- 
taws,    Chicasaws,  Seminoles,   Cheyennes,  Arapahoes,  Assne- 
boines.     It  is,  however,  an  almost  universal  agent,  and,  whether 
among  our  own  Indians,  the  Mexicans,  or  natives  of  South 
America,  the   Yedas   of  India,   the    ancient   Ainos,   or    the 
modern  Japanese,  the  inhabitants  of  the  Caucasus,  or  of  the 
Himalayas,  of  the  Australian  Islands,  or  of  Africa,  we  find  that 


194  LABOR:    AN  ETHNOLOGICAL    STUDY. 

massage  is  everywhere  the  main  and  almost  the  only  reliance 
in  labor. 

Ill,  Shaking  up  of  the  Patient. — Though  not  strictly  within 
the  sphere  of  this  paper,  I  will  briefly  refer  to  some  of  those 
peculiar  and  barbarous  methods  to  which  these  primitive  peo- 
ple resort  in  their  despair.  We  have  already  observed  how, 
in  Mexico,  the  tenedora  raises  the  patient  up  and  drops  her, 
catching  her  with  a  shock  so  as  to  shake  out  the  uterine  con- 
tents, shaking  out  the  child  from  the  womb  as  she  would  flour 
out  of  a  sack.  In  Southern  India,  they  shake  her  several  times  | 
to  promote  delivery,  but,  if  this  does  not  answer,  they  roll  the 
patient  upon  the  ground,  or  suspend  her  by  her  feet  and  shake 
her  several  times.  The  object  of  this  is,  evidently,  after  they 
have  seen  that  the  child  cannot  be  expelled  in  the  natural  way, 
to  throw  the  fetus  out  of  the  pelvis  proper  into  the  roomier 
upper  portion,  so  that  it  may  change  its  position,  and  come  with 
head  or  breech  flrst.  We  find  a  precisely  similar  custom 
among  the  Nez-Perces  Indians,  who  take  the  patient,  if  labor 
is  prolonged,  reverse  her,  and  whilst  the  head  rests  upon  the 
ground,  shake  the  body  vigorously  in  the  air ;  then  they  lead 
her  to  a  stake  again  and  see  if  the  condition  of  affairs  is  at  all 
improved;  if  not,  the  process  is  again  repeated.  This  they  do 
several  times,  and,  if  finally  it  proves  of  no  avail,  the  midwife 
introduces  her  hand,  and  pulls  at  whatever  she  can  reach.  If 
it  happens  to  be  a  foot,  well  and  good ;  if  it  happens  to  be  an 
arm,  the  patient  will  probably  be  so  injured  that  death  results, 
as  my  correspondent  tells  me  he  has  never  heard  of  a  woman 
surviving  the  graver  accidents  of  parturition.  The  Esthonians 
hold  the  patient  in  the  air,  shaking  her  vigorously  if  labor  is 
retarded.  In  Syria,  the  patient  is  rolled  in  a  blanket  if  she  is 
not  confined  within  twenty-four  hours  after  the  commencement 
of  labor,  and  four  male  or  female  friends  seize  the  corners  of 
the  blanket  and  roll  the  poor  woman  about  in  various  direc- 
tions, and  bounce  her  up  and  down  to  facilitate  confinement. 

IV.  Permanent  Pressure. — Bandages  of  cloth  or  leather, 
ropes  or  belts,  are  occasionally  resorted  to,  but  are  not  found  as 
often  as  in  the  lying-in  room  of  civilization.  They  are  used 
here  and  there  in  pregnancy,  labor,  and  child-bed.  In  preg- 
nancy, the  binder  is  used  in  Japan  from  about  the  fifth  month 
on  to   prevent  the  growth  of  the  child,  so   that  it  may  not 


MASSAGE  AND  EXPRESSION.  195 

become  too  large,  and  delivery  may  be  easy.  In  India  and  in 
Burmah,  as  well  as  among  one  or  two  of  our  own  Indian 
tribes,  the  bandage  is  used,  tightly  worn,  after  the  seventh 
month,  in  order  that  the  uterus  may  not  ascend  too  higli,  that 
the  child  may  not  have  so  far  to  go  whon  it  wishes  to  escape. 
In  labor,  the  simple  binder  is  rarely  resorted  to.  Usually 
when  the  binder  is  applied,  it  serves  as  an  active  means  of 
compression  ;  but  among  one  of  the  Indian  tribes,  as  we  have 
seen,  the  simple  belt  is  used,  which  is  pressed  down  so  as  to 
follow  the  uterus  with  each  pain.  In  child-bed,  or  rather  in 
the  time  following  delivery,  as  the  bed  is  but  rarely  resorted  to, 
the  binder  plays  a  very  insignificant  part.  We  have  seen,  es- 
pecially among  the  Sioux,  the  squaw  belt  used,  but  it  is  worn 
for  only,  perhaps,  twelve  hours  after  labor.  In  Mexico,  a  tight 
bandage  is  sometimes  used,  or  a  rope.  In  Old  Calabar,  a 
simple  handkerchief  answers  the  purpose.  The  Kiowas, 
Comanches,  and  several  other  Indian  tribes  use  it;  but  whether 
travellers  or  other  authorities  who  have  written  upon  the  sub- 
ject neglected  to  mention  the  binder  or  not,  I  rarely  hear  of  it. 

D.       THE    USES    OF    MASSAGE    AND    EXPRESSION. 

In  speaking  of  the  different  kinds  of  external  manipulations 
and  the  various  methods  of  applying  them,  we  have  naturally 
spoken  to  some  extent  of  the  purposes  for  which  they  are  used. 
But  it  may  be  well  to  consider  these  somewhat  more  in  detail, 
and  I  will  endeavor  to  describe  the  various  purposes  served  by 
these  external  manipulations  in  pregnancy,  labor,  and  in  child- 
birth. 

I.  Pregnancy. — Steady  pressure,  as  wo  have  seen,  is  used  to 
prevent  the  undue  growth  of  the  ovum  ;  but  massage  properly 
is  resorted  to  for  the  purpose  (1)  of  correcting  malpositions. 
Thus,  in  Japan,  the  medicine-man  manipulates  the  abdomen  of 
the  patient,  who  clings  about  his  neck,  pressing  his  shoulders 
against  her  breasts,  and  pressing  his  knees  between  hers,  so 
that  slie  is  firmly  supported.  Then  he  practises  a  lateral  mas- 
sage with  his  hands,  beginning  at  the  seventh  cervical  vertebra, 
and  rubbing  downward  and  forward,  rubbing  also  the  nates  and 
liips  with  the  palms  of  his  hands,  repeating  the  movement  from 
sixty  to  seventy  times  every  morning  after  the  fifth  month. 
This,  I  judge,  i>  only  in  case  of  wealthy  or  handsome  patients, 
or  when  malpositions  are  expected  for   certain    superstitious 


196  LABOR:    AN  ETHNOLOGICAL    STUDY. 

reasons.  By  far  more  frequently  is  massage  used  for  the 
purpose  (2)  of  producing  ahortion.  Among  some  of  our  own 
Indians,  the  Piutes  among  others,  many  of  the  natives  of 
Australia,  the  inhabitants  of  the  Sierra  Leone,  and  of  the  in- 
terior of  Africa,  the  Loango  negroes,  and  others,  produce 
abortion,  either  by  firmly  kneading  and  rubbing  the  abdomen 
with  the  hands,  or  pounding  and  working  it  with  their  fists. 
Many  do  it  for  criminal  purposes,  others  because  they  dread 
the  often  fatal  labor  with  half-breed  children.  This  is  a  some- 
what remarkable  circumstance,  but  true  among  our  own  Indians 
upon  the  Pacific  Coast  and  in  the  interior,  in  Australia,  and  in 
India,  that  labor  following  intercourse  with  whites  is  always 
tedious  and  dangerous,  frequently  ending  in  the  death  of 
both  mother  and  child.  Hence  they  produce  abortion  in  prefer- 
ence to  undergoing  this  ordeal.  In  India  and  in  Africa, 
abortion  is  often  produced  when  the  mother  is  suckling  one  in- 
fant and  finds  herself  pregnant  with  another. 

II.  Labor. — Massage  in  (1)  normal  labor  is  almost  invari- 
ably used  unless  the  case  be  a  very  simple  and  rapid  one,  or  the 
poor  sufferer  be  without  friends  and  means.  It  serves  the 
purpose  of  improving  or  correcting  the  position  of  the  child,  of 
stimulating  the  uterine  contractions,  and  of  directly  aiding  by 
mechanical  pressure  the  muscular  action.  A  slight  variation, 
ordinary  flexion  and  pressure  upon  the  abdomen,  regular  mas- 
sage, combined  with  expression,  is  used  in  ordinary  cases. 

(2.)  Malposition. — In  cases  of  malposition,  which  are  only 
discovered  by  the  simple  fact  that  the  child  is  not  expelled  in 
proper  time,  more  violent  means  are  resorted  to,  such  as 
forcible  kneading,  shaking,  tossing  in  a  blanket,  and  tramping 
upon  the  abdomen.  Thus,  by  violent  means,  there  is  a  pos- 
sibility of  forcing  the  child  into  its  proper  axis,  with  breech  or 
head  in  the  pelvis,  and  this  done,  of  forcing  it  out  through  the 
natural  passages.  These  external  manipulations  are,  as  we 
have  seen,  their  only  resort;  and  as  death  is  the  consequence 
of  an  undelivered  child,  every  means  in  their  power  must  be 
taken  to  expel  it ;  and  these  very  forcible  means  must  almost 
inevitably  force  a  rupture  somewhere.  If  the  child  is  not 
crowded  out  through  the  natural  outlet,  a  place  of  least  resist- 
ance will  be  found  elsev/here ;  the  womb  or  abdominal  walls 
must  give  way.     The  child  must  out  or  the  patient  must  die. 


MASSAGE  AND   EXPRESSION.  197 

(3.)  Placenta.  The  placenta  usually  follows  the  child,  but 
unless  this  is  the  case,  massage  and  expression  are  invariably 
resorted  to.  Frequently  the  patient  retains  the  same  position 
which  she  assumed  during  labor,  and  the  attendants  continue 
the  same  manipulations  until  the  after-birth  is  expelled.  Rarely 
does  she  assume  a  different  position,  as  among  the  Sioux,  where 
the  squaw  belt  is  used,  the  parturient  jumps  up  after  tlie 
delivery  of  the  child,  draws  tight  her  belt,  and  thus  forces  out 
the  placenta.  Then,  again,  others  press  with  the  abdomen 
against  a  staff  fast  in  the  ground.  In  short,  the  milder  means 
of  massage  and  expression  are  used  in  this  stage  of  labor  by  the 
various  people.  It  may  be  again  remarked  that  primitive 
people,  odd  as  it  may  seem,  rarely  pull  upon  the  cord,  but  in 
most  instances  use  the  vis  a  tergo,  stimulate  the  activity  of  the 
womb  by  friction  of  the  fundus,  and  press  out  the  contents. 
Massage,  combined  with  expression  of  various  kinds,  never 
very  forcible,  is  used  in  this  stage  of  labor. 

III.  Child-bed.  I  have  not  found  any  reference  to  the  use 
of  massage  after  the  expulsion  of  the  placenta.  Expression,  of 
course,  does  not  come  in  question  ;  but  permanent  pressure,  as 
we  have  already  seen,  is  occasionally  used.  I  will  not  here 
again  refer  to  it,  as  being  really  foreign  to  our  subject.  In 
some  few  instances,  as  among  certain  tribes  upon  the  Pacific 
coast,  some  pressure  is  at  times  exercised  upon  the  abdomen 
during  the  first  day  after  confinement,  the  patient  walking 
about,  occasionally  stops  to  lean  with  the  abdomen  upon  a  staff,  ^ 

and  the  compression  of  the  uterus  forces  out  the  discharge.  . 

Among  some  of  the  Indian  tribes,  but  especially  among  the     y^^.  ■ 
natives  of  Africa  and  India,  the  infant  is  thoroughly  kneaded  v     ,^' 
and  massaged  after  each  bath ;  and  this  very  excellent  proce- 
dure undoubtedly  serves  to  strengthen  the  tender  muscles. 

£.       THE    DEVELOPMENT  OF    EXTERNAL    MANIPULATION  IN    RECENT     /^r 
OBSTETRIC    PRACTICE. 

The  use  of  external  manipulation  in  child-birth  is,  as  we  have 
seen,  a  most  ancient  and  venerable  practice,  forgotten  by 
civilization  for  ages,  and  only  of  late  years  again  accorded 
the  importance  which  simple-minded,  primitive  people  have 
always  conceded  to  it. 

Phclippeaux,  in  his  "  Etude  Pratique  sur  les  Frictions  et 
le  Massage,"  Paris,  1870,  justly  says:  Within  a  few  years,  in 


198  LABOR:  AN  ETHNOLOGICAL   STUDY. 

the  presence  of  numerous  well- authenticated  and,  we  may 
almost  say,  marvellous  facts,  a  return  has  been  brought  about 
to  a  legitimate  and  long-forgotten  practice.  To-day  the  most 
illustrious  masters  look  kindly  upon  a  method  of  treatment  as 
old  as  the  world,  which  has  now  been  deprived  of  the  sur- 
rounding fables  and  charlatanism.  The  use  of  external  man- 
lipuiations  in  obstetric  practice  has  rapidly  advanced  in  import- 
ance in  the  course  of  this  century.  In  1812,  "Wigand  discovered 
the  important  fact  that,  by  the  aid  of  external  pressure,  mal- 
positions could  be  corrected  ;  but  his  views,  although  addressed 
to  the  academies  of  Berlin  and  Paris,  were  neglected  and  for- 
gotten :  yet  he  had  only  stated  distinctly  what  Hippocrates 
had  vaguely  indicated,  and  what  Jacob  Rueffius  and  Mercurius 
Scipio  had  urged.  The  Hamburg  obstetrician  was  forgotten 
until  1859,  when  the  translation  of  his  work  by  Belin  and  Her- 
gott  appeared  in  Strasburg.  This  was  taken  up  by  Stoltz  and 
Cazeaux.  Then  comes  Wright,  of  Cincinnati,  and,  soon  after, 
Braxton  Hicks,  to  whom  the  credit  has  so  long  been  unjustly 
given ;  and  in  1853  and  in  1860,  Crede,  who  so  earnestly  advo- 
cated delivery  by  means  of  expression,  endeavoring  to  imitate 
nature  as  nearly  as  possible  by  provoking  uterine  contractions, 
forcing  the  descent  by  a  vis  a  tergo,  the  liand  never  touching 
the  genitals  of  the  patient,  the  entry  of  air,  as  well  as  trauma- 
tism, were  impossible.  Crede's  method  was  already  indicated 
by  Busch  in  1803.  Then,  in  1867,  comes  Kristeller,  advocat- 
ing uterine  expression  for  the  delivery  of  the  child  itself;  and, 
in  1865,  Martin,  of  Berlin,  attempted  to  obtain  the  after-coming 
head  by  means  of  manual  expression  after  the  delivery  of  the 
body.  Although  Crede's  method  is  so  perfectly  natural,  sim- 
ple in  principle,  and  easy  in  application,  it  has  yet  but  slowly 
asserted  itself.  Even  in  Germany,  among  his  immediate  sur- 
roundings, it  was  a  long  time  before  the  method  gained 
ground.  (L'Expression  Uterine,  A.  T.  Suchard,  Paris,  1872.) 
In' 1856,  von  Ritgen  urged  that  the  forceps  should  never  be 
used  without  the  accompanying  aid  of  manual  expression,  and 
Seyfert,  of  Prague,  pointed  out  the  merits  of  these  methods  at 
every  possible  opportunity,  on  account  of  his  great  aversion  to 
all  such  methods  of  delivery  which  necessitated  the  introduc- 
tion of  hand  or  instrument  into  the  genital  tract.  He  sought 
to  obtain  the  delivery  of  the  uterine  contents  as  does  nature 
herself,  by  pressure  from  above,  not  by  traction  from  below. 


MASSAGE  AND  EXPRESSION.  I99 

Massage  and  expression  being  the  only  resort  in  the  hands 
of  primitive  people  for  the  completion  of  difficult  labor,  they 
iutuitively,  by  instinct  and  by  long  practice,  not  by  scientific 
reasoning,  of  course,  have  brought  them  to  a  certain  state  of 
perfection,  although  brute  force  is  more  relied  upon  than  dex- 
terous manipulation.  The  methods  are  so  simple,  so  natural, 
and  so  thoroughly  in  accordance  with  sound  mechanical  prin- 
ciples, that  they  have  produced  good  results.  Deprived  of  the 
brutality  of  physical  force  and  aided  by  science,  these  very 
means  which  have  so  long  and  so  well  served  the  ignorant  will 
attain  a  high  degree  of  perfection,  and  will  serve  by  far 
better  the  scientific  obstetrician. 

Literature. 

I  have  not  here  referred  to  my  authorities,  as  I  have,  in  my 
earlier  papers,  given  due  credit  to  the  numerous  professional 
brethren  who  have  so  kindly  and  so  indefatigably  aided  me  in  my 
work.  I  have  compiled  the  facts  here  given  from  the  same  data; 
/.  e.,  information  gathered  from  individual  friends,  from  the  let- 
ters received  from  the  Sargeous  of  the  U.  S.  A.,  and  from  the 
Agency  Physicians  in  response  to  the  circular  letter  of  inquiry, 
sent  by  Major  Powell,  of  the  Bureau  of  Ethnology  of  the  Smith- 
sonian Institution;  from  medical  works  and  the  reports  of  travellers, 
especially  the  Zeitschrift  fiir  Ethnologic,  and  the  following  books 
and  papers,  bearing  more  particularly  upon  massage.  From  the 
first  three  I  have  drawn  largely;  of  the  last  three  I  have  only  seen 
exl^'acts. 

A.  F.  SucHARD  :  De  I'Expression  Uterine  Applique  an  Foetus. 
Paris,  1872. 

Le  Dr.  Phelippeaux  :  Etude  Pratique  sur  les  ^Frictions  et  le 
Massage.     Paris,  1870. 

Dr.  Bela Weiss:  Die  Massage,  ihre  G-eschichte,  ihre  Anwendung 
undWirkung.     Wiener  Klinik,  xi.  u.  xii.,  Nov.  and  Dec,  1879. 

Dr.  J.  Estradere.    Paris,  1863. 

Savary:  Etude  Pratique  sur  les  Frictions  et  le  Massage,  par  M. 
Le  Dr.  Phelippeaux.     Paris.     Delahaye,  p.  116. 

K.  Krebel  :  Vulksmedizin  u.  Volksmittel  verschiedener  Vol- 
kerstamme  Kusslands.     Leipzig  et  Heidelberg,  1858. 

HuREAU  de  Villeneuve  :  De  I'Accouchement  dans  la  race 
Jaune.     These  de  Paris,  1863. 

Mallat  :  Les  Phillipines.     Paris,  1826. 

Dr.  Leclerc  :  Une  Mission  Medicale  en  Kabylie.  Paris, 
1846. 


200  LABOR:  AN  ETHNOLOGICAL  STUDY. 

MosENGEiL  :  Archiv  f.  klin.  Chirurgie,  19,  p.  551. 

Gerst  :  Ueber  den  tlierapeutischen  Wertli  der  Massage. 
Wiirzburg,  1879. 

Crede  :   Monatsschrift  f.  Geburtsk.,  vol.  xvi.,  p.  274,  1861. 

MuNDE,  P.  F. :  Palpation  in  Obstetrics.  Am.  Jour.  Obstet., 
October,  1879,  and  April,  1880. 


CIIAPTEK  Y. 


CHARACTERISTIC  LABOR  SCENES  AMONG  THE 
YELLOW,  BLACK  AND  RED  RACES. 


In  the  preceding  chapters  I  have  endeavored  to  describe 
the  details  of  treatment  habitual  among  various  people, 
in  the  different  stages  of  labor,  especially  the  position  oc- 
cupied by  the  parturient;  and  as  a  fitting  close  to  this  little 
volume,  I  will  now  relate  individual  labor  scenes  among 
Mongolians,  Indians  and  Negroes,  which  may  be  regarded 
as  typical,  so  far  as  that  is  possible.  And  these  will,  I 
trust,  serve  for  the  better  understanding  of  the  peculiarities 
in  the  management  of  childbirth  as  customary  among  these 
races. 

MONGOLIANS. 
The  Japanese  and  the  Ainos,  the  aborigines  of  Japan,  as 
well  as  the  Kalmucks,  must  serve  as  a  type  of  the  yellow 
races :  the  obstetric  customs  of  the  former  are  so  well  de- 
scribed by  my  friend  Dr.  J.  C.  Cutter,  of  Kaita  Kuschi,  Lap- 
pou,  Japan,  in  his  kind  response  to  my  circular  letter,  that 
I  can  do  no  better  than  follow  him  verbatim,  after  picturing 
the  treatment  of  the  pregnant  woman  as  detailed  to  me  by 
Dr.  N.  Kauda,  of  Tokio. 

JAPATTESE. 

Dr.  Kauda  says  :  "  During  the  fifth  month  after  concep- 
tion the  pregnant  woman  first  consults  a  midwife,  who 
binds  her  abdomen  with  a  band  of  cloth,  one  foot  wide  and 
six  and  one-half  feet  long,  which  is  never  removed  until  the 
delivery  of  the  child,  although  occasionally  changed.  This 
binding  of  the  abdomen  is  for  the  purpose  of  preventing 
the  growth  of  the  child,  in  order  that  delivery  may  be  made 
easy.  About  three  times  a  month  the  midwife  comes  to 
rub  the  abdomen,  and  in  the  seventh  month  preparations  are 
made  for  the  approaching  labor." 


202  LABOR:  AN  ETHNOLOGICAL  STUDT. 

In  reference  to  tlie  present  inhabitants  of  Japan,  Dr.  Cut- 
ter says  : 

"  With  regard  to  the  assistants  who  attend  the  partu- 
rient woman,  I  may  state  that  it  is  very  rare  that  a 
man  is  present  during  confinement ;  the  lady  (or  coolie- 
woman)  is  assisted  in  her  labor  by  a  sarrhba-san — i.  e.,  a  fe- 
male in  reduced  circumstances.  Usually  this  is  not  an  ed- 
ucated midwife,  but  some  elderly  woman,  or  widow,  who 
has  been  taught  her  duties  by  a  former  samha-san. 

"At  present  there  is  a  school  at  Tokio  for  the  education  of 
midwives  ;  and  at  all  of  the  hospitals  in  the  empire  instruc- 
tion can  be  secured  from  the  medical  oflficers  of  the  same,  by 
women  desirous  of  becoming  midwives.  The '  Home  De- 
partment Instructions, 'issued  in  the  9th  year  of  Meiji  (1876) 
contains  the  following : 

"  'Art.  2.  Anyone  desirous  to  become  an  obstetrician,  ocu- 
list or  dentist,  can  obtain  a  license  after  he  or  she  has 
satisfactorily  passed  an  examination  in  the  general  princi- 
ples of  anatomy  and  physiology,  and  in  the  pathology  of 
such  parts  of  the  body  as  he  or  she  has  to  treat.' 

"  Such  is  the  regulation  ;  in  Tokio  its  provisions  may  be 
insisted  upon — in  other  parts  of  the  empire  I  have  doubts 
about  its  enforcement. 

"  The  Japanese  women  are  healthy,  well  formed,  and  well 
developed,  as  they  have  not  been  injured  by  the  fashionable- 
torture  apparatuses  in  use  in  Europe  and  America.  Hence, 
in  the  majority  of  the  cases,  the  samha-san  has  only  to  re- 
ceive the  child  and  to  remove  the  placenta.  The  Japanese 
females  all  have  roomy  pelves,  and  naturally  they  do  not 
look  forward  with  dread  to  their  confinement,  having, 
moreover,  implicit  confidence  in  the  powers  of  nature  to  do 
iill  that  will  be  required  in  their  case. 

"  When  the  time  of  confinement  approaches,  a  thick, 
padded  futon  (i.  e.,  a  thin,  cotton-filled  mattress)  is  placed 
on  the  tatame  or  straw  matting.  At  one  end  a  number  of 
futon  are  rolled  up  and  used  as  cushions,  against  which  the 
parturient  reclines,  occupying  the  usual  Japanese  posture, 
i.  e.,  as  in  the  illustration.     The  knees  are  bent,  the  legs 


THE  YELLOW,  BLACK,  AND  RED  RACES. 


203 


under  the  thighs,  and  to  the  outside,  the  toes  outwards  ;  the 
knees  are  separated  during  the  delivery  of  the  child.  Before 
the  patient  are  often  placed  a  pile  of  futon  or  a  chair  or 


Fig.  56. 


peculiar  stool,  against  which  she  leans  ;  in  other  cases  a 
female  friend  takes  the  usual  posture  in  front  of  her,  and 
another  behind  her  to  support  the  wear j  body,  to  hold  her 
head,  and  even  to  exert  a  hugging  pressure  about  the  abdo- 
men. The  samba-san  rubs  the  abdomen,  lightly  percusses 
it,  and  even  exerts  pressure.  Later  she  receives  the  child 
as  it  presents  and  holds  it  up  while  being  expelled.  The 
uterus  is  not  followed  down  by  abdominal  pressure. 

"  The  placenta  is  obtained  in  the  same  posture ;  in 
almost  all  cases  the  samba-san  puts  two  loops  on  the  cord, 
severs  it  and  waits  for  the  placenta  to  appear.  Occasion- 
ally she  uses  traction  and  abdominal  pressure.  After  this 
a  thick  sash,  or  o&e,  is  wound  several  times  about  the  body, 
and  the  mother  then  reclines  upon  the  futon. 

''  During  pregnancy,  the  ladies  avoid  unpleasant  sights, 
sounds  and  conversations.  They  will  not  eat  of  rabbit  or 
hare,  willingly,  for  fear  of  the  production  of  '  hare-lip : ' 
in  some  provinces  they  will  eat  no  flesh  during  this  period, 
in  others,  during  the  last  twenty-one  days  of  the  pregnancy, 
the  woman  withdraws  to  a  separate  room — a  wealthy  lady 
to  a  separate  house.  This  seclusion  is  continued  for  twenty- 
one  days  after  delivery ;  then  she  also  has  food  prepared 
apart  from  that  of  the  remainder  of  the  household. 


204  ^-4^ OR:  AN  E THNOL O GICAL  STUDY. 

"  Before  confinement  additional  religious  duties  are  not 
often  undertaken  :  the  patient  rarely  makes  special  visits 
to  the  temple,  rarely  enlarges  lier  cliaritalble  duties.  She 
merely  takes  several  baths,  changes  all  her  garments,  sets 
aside  changes  of  under- wear,  and  now  patiently  and  quietly 
awaits  the  workings  of  nature. 

"  After  labor,  as  we  should  say  during  the  period  of 
child-bed,  the  Japanese  mother  keeps  to  her  house  twenty- 
one  days.  On  the  seventh  day,  if  all  is  favorable,  or  later, 
on  the  twenty-first  day  after  delivery,  a  dinner  is  given  to 
all  the  relatives.  If  it  is  a  boy,  there  are  then  great  re- 
ioicings  and  long-drawn  out  wordy  congratulations ;  if  a 
girl,  all  expressions  are  severely  moderated. 

"  If  a  girl,  on  the  thirty-first  day,  if  a  boy,  on  the  fiftieth 
day,  the  mother,  the  child,  and  special  female  friends  go  to 
the  temple.  The  Bonze  recites  special  prayers,  and  gives 
the  mother  a  special  protecting  prayer  written  on  the  temple 
paper,  which  is  many  times  folded  and  then  deposited  in  a 
girdle-bag. 

"  Some  peculiar  customs  are  observed  with  regard  to  the 
after-birth:  the  umbilical  cord  is  severed  from  the  pla- 
centa, wrapped  in  several  thicknesses  of  white  paper,  then  in 
a  paper  containing  the  father's  and  mother's  names  in  full. 
Thus  prepared  it  is  laid,  aside  with  the  family  archives.  If 
the  child  dies,  it  is  buried  with  him ;  if  he  lives  to  adult 
age,  he  constantly  carries  it  about  with  him,  and  at  last  it 
is  buried  with  him. 

"  The  placenta  itself  is  taken  from  the  room  in  an  estab- 
lished form  of  earthen  vessel:  if  it  is  a  boy's,  a  stick 
of  India  ink  and  a  writing  brush  are  placed  with  it ;  if  a 
girl's,  nothing.  In  either  case,  the  placenta  is  buried  deep  in 
the  earth,  beyond  the  reach  of  dogs." 

THE     KARArUTO     AINOS,     OF     ISCHAEI     VALLEY    OF 
HOKKAIDO  (YEZO). 

"  Among  these  people,  the  original  inhabitants  and  rulers 
of  Japan,  the  parturient  is  assisted  by  an  elderly 
female,  who  has  had  several  children    but  is  not  spe- 


THE  YELLOW,  BLACK,  AND  RED  RACES.  205 

cially  instructed  for  her  office,  nor  esj^ecially  selected 
for  her  intelligence.  Other  females,  at  times,  come  to  the 
hut,  but  take  no  active  part.  If  the  labor  is  much  de- 
layed, and  the  woman  becomes  exhausted,  her  hus- 
band is  called  in  to  help  support  her ;  the  priest 
is  sent  for,  to  prepare  some  white  sticks,  which  are 
shaved  down  from  one  end  to  form  an  object  not  unlike 
a  New  England  split  wood  broom,  whose  fibers  have  not 
been  bent  back  to  be  confined  by  the  cord ;  these  latter 
are  stuck  into  the  ground  about  the  hut,  leaving  the  frayed 
edges  upper-most.  If  an  arm  or  a  leg  presents,  the  fetus, 
whole  or  part,  is  pulled  away  by  sheer  force,  usually 
with  fatal  result,  not  only  to  the  fetus,  but  to  the 
mother.  Their  resorts  in  difficult  cases  are  very  limited, 
and  it  is  not  infrequent  for  the  mother  to  perish  from  hem- 
orrhage. The  only  instrument  in  use  is  a  thong  or  cord  for 
traction  during  impaction  or  mal-presentation. 

"  As  the  Ainos  meuoTci  not  only  spins  and  weaves  the 
tree-fibers,  but  aids  in  hunting,  fishing,  bearing  burdens  and 
drawing  loads,  she  is  usually  of  a  strong,  vigorous  frame, 
and  of  excellent  development.  She  possesses  a  roomy  pel- 
vis with  well  proportioned  adjuncts,  and  rarely  suffers  from 
disease,  excepting  syphilis,  parasites,  and  occasional  indi- 
gestion from  gluttony. 

''  Position. — The  houses  in  which  the  people  live  are  very 
rude ;  sometimes  a  cave  in  the  hill-side,  with  a  hole  in  the 
roof  for  smoke ;  more  often,  a  rude  pole  structure,  thatched 
on  roof  and  sides  with  long  wild  grass.  In  the  center  of 
the  one  large  room  is  an  open  fire ;  at  one  end  of  the 
room  may  be  a  narrow  board  floor;  around  the  sides 
are  collections  of  straw  and  old  garments,  upon  which 
men,  women,  children  and  dogs  sleep  promiscuously.  The 
wealthy  ones  have  a  few  blankets,  an  occasional  futon y 
and  now  and  then  a  tatame.  The  majority  live  in  a  very 
wretched  manner. 

"  Scanty  preparations  are  made  for  approaching  labor ; 
shortly  before  full  time  the  exj^ectant  mother  gathers  a 
small  amount  of  a  peculiar  fine  white  grass,  wliich  is  care- 


206  LABOR:  AN  ETHNOLOGICAL  STUDT. 

fully  dried,  and,  on  the  day  of  tlie  delivery,  spread  out 
on  tlie  floor  or  ground  on  one  side  of  the  fire.  During  the 
early  part  of  the  labor  she  attends  to  simple  duties,  or  re- 
clines at  pleasure  on  the  straw  or  mats.  At  the  onset  of 
active  labor  pains  she  approaches  the  fire,  drops  on  her 
knees,  then  separates  them,  and  rests  back  on  her  heels, 
while  her  toes  are  extended  outwards.  The  midwife  faces 
her ;  between  them  a  rope  with  knots  or  cross  sticks  is  sus- 
pended from  the  roof.  This  is  seized  by  the  parturient, 
who  pulls  lustily  upon  it.  The  midwife  helps  to  sustain 
her  in  this  position.  The  child  is  dropped  on  the  straw  be- 
tween the  mother's  legs,  and  is  not  molested  until  the 
placenta  appears.  A  noose  is  put  about  the  cord,  when  the 
latter  is  cut.  The  midwife  takes  up  the  child,  and  spurts 
a  mouthful  of  cold  water  upon  its  chest ;  if  it  screams 
lustily  it  is  a  good  child,  otherwise,  not  much  is  thought 
of  it. 

"  Placenta. — The  patient  remains  in  her  position,  and 
the  placenta  usually  appears  in  a  short  time ;  if  not,  the 
old  woman  pulls  it  out.  From  this  latter  procedure,  hem- 
orrhages are  not  infrequent.  I  have  yet  to  learn  that  mas- 
sage or  pressure  is  used  at  this  stage.  A  tree-fiber  girdle  is 
now  assumed  outside  of  the  usual  Mmono,  or  flowing  gar- 
ment. 

"The  labor  generally  lasts  from  eight  to  forty-eight  hours. 
The  child  is  not  washed,  but  is  wrapped  iip  in  an  old  inomu 
(a  cloth  made  of  the  inner  fibers  of  a  yezo  tree) :  it  is 
allowed  to  suckle  from  three  to  five  years,  and  even  longer, 
and  is  carried  about  on  its  nurse's  back  under  the  outer 
garments  and  next  to  the  skin. 

"  Tbey  have  no  obstetrical  instruments.  Abortion  is 
practiced  occasionally  as  well  as  feticide,  which  is  usually 
brought  about  by  blows,  compression,  and  external  vio- 
lence. Infanticide  is  extremely  rare,  as  the  mothers  have 
a,  tradition  that  the  next  child  will  be  blind. 

"  The  Ainos  live  as  nearly  as  possible  in  a  state  of  nature. 
They  have  little  or  no  ceremony  at  child-birth  ;  before  labor, 
the  mother  pursues  her  ordinary  avocations  as  long  as  she 


THE  YELLOW,  BLACK,  AND  RED  RACES.  207 

can ;  after  it  is  over,  she  considers  it  her  duty  to  resume  lier 
work  as  soon  as  possible.  The  father  and  the  friends 
often  imbibe  of  rice  scike  too  freely.  I  have  learned  of  no 
religious  or  superstitious  ceremony." 


KALMUCKS. 

The  Kalmucks,  the  most  numerous  of  all  the  Mongolian 
people,  may  well  serve  as  a  type  of  the  natural  Mongolian, 
as  they  are  nomads,  without  a  fixed  home,  roaming  over 
mountain  and  plain,  unaffected  by  civilization ;  whether 
belonging  to  Europe  or  Asia,  they  inhabit  only  the  most  re- 
mote and  inaccessible  parts  of  either  country,  and  yet  they 
are  far  in  advance  of  the  nomads  of  the  far  north.  For 
their  medical  knowledge  the  Kalmucks  are  indebted  to  the 
Buddhists,  to  the  schools  of  Thibet,  founded  for  the  Lamas  ; 
among  them  medicine  is  a  divine  knowledge,  and  possesses 
its  especial  idol,  Burchan.  For  the  following  excellent  de- 
scription of  their  obstetric  customs  I  am  indebted  to  Dr. 
Rudolph  Krebel's  work :  Yolksmedizin  und  Volksmittel 
verschiedener  Yolkerstamme  Russlands.  (Leipzig  &  Heidel- 
berg.    1858.) 

"  As  soon  as  labor  begins,  the  friends  of  the  patient  as- 
semble ;  their  idol  is  brought  forth,  conspicuously  placed 
above  the  sufferer's  couch,  and  illuminated  with  a  lamp. 
The  parturient  now  takes  to  her  bed  in  expectation  of  the 
coming  pains,  during  which  she  squats,  her  buttocks  rest- 
ing upon  her  heels,  grasping  with  her  hands  a  pole,  which 
is  firmly  attached  to  the  chimney,  and  of  sufiicient  length 
to  afford  her  a  comfortable  support ;  behind  her  sits  another 
woman,  who  compresses  her  body  with  both  arms  ;  but,  if 
in  better  circumstances,  the  husband  takes  some  vigorous 
young  fellow  into  his  '  kibitke,'  who,  after  being  hospitably 
treated,  takes  his  seat  on  the  floor,  with  the  parturient  on 
his  knees,  and  with  his  arms  encircling  her  body,  he  com- 
presses the  abdomen  and  with  the  palms  of  his  hands  rubs 
the  uterine  surface,  being  careful  to  stroke  it  from  above 
downward,  and  to  exercise  compression  in  the  same  direc- 
tion.   As   soon  as  the  female   attendant  observes  the  ap- 


208  LABOR:  AN  ETHNOLOGICAL  STUDY. 

pearance  of  tlie  "head  in  the  vulva,  slie  signals  tlie  crowd  of 
men  who  have  been  waiting  outside,  who  simultaneously  fire 
their  guns,in  order  to  assist  nature  by  the  sudden  fright  v/hich 
this  will  cause  the  patient.  The  poor  either  buckle  broad 
leather  belts  around  the  abdomen  of  the  patient  as  soon  as 
labor  begins,  and  try  to  hasten  matters  by  pressure  from 
above  downward,  or  they  press  a  cloth  firmly  over  mouth 
and  nose  of  the  woman  to  try  the  effect  of  choking,  so  that 
the  exertions  of  the  struggling  sufferer  may  possibly  expel 
the  tardy  fetus. 

"  It  is  said  that  in  difficult  cases  female  assistants  have 
for  ages  practiced  version,  and  physicians  among  the  Son- 
gars  have  performed  embryotomy  with  the  knife.  We 
hardly  need  mention  that  superstitions  play  an  important 
part  in  their  management  of  labor. 

"  The  young  mother  is  looked  upon  as  unclean  for  three 
weeks  after  confinement ;  she  is  never  abed  at  any  time 
over  seven  days  during  the  puerperal  state.  Immediately 
after  delivery  mutton  is  given  the  patient,  but  only  a  little 
at  a  time,  whilst  broth  is  given  in  considerable  quantities  ; 
the  amount  of  meat  used  is  gradually  increased. 

'•  As  soon  as  the  child  is  born,  the  cord  is  tied  and  cut, 
and  the  placenta  buried  at  a  considerable  depth  within  the 
'  kibitke.'  The  child  is  washed  in  salt  water  and  wrapped 
in  furs.  The  remnant  of  tlie  cord  is  carefully  preserved, 
and  kept  as  a  charm,  considered  especially  valuable  in  their 
petty  lawsuits.  Until  the  remnant  of  the  cord  separates 
from  the  child,  the  father  does  not  permit  fire  from  the  hearth 
to  be  taken  from  his  hut.  The  wealthy  sometimes  keep  a 
wet  nurse  ;  the  poor  nurse  their  own  children,  not  unfre- 
quently  up  to  the  very  time  when  prevented  by  a  succeed- 
ing pregnancy.  Additional  nourishment  is  given  the  child 
during  the  first  year.  During  the  first  days  the  infant  is  not 
given  the  breast,  but  a  piece  of  raw  mutton  tallow  to  suckle. 
The  mortality  is  great  among  children,  esi)ecially  during 
the  second  year,  on  account  of  coarse  food  and  hereditary 
syphilis." 


THE   FELLOW,  BLACK,  AND  RED  RACES.  209 

NEGROES. 


LOANGO-NEGROES. 

I  have  cliosen  the  Baiiotos,  or  negroes  of  Loango — a  peo- 
ple of  Central  Africa — as  representatives  of  the  Blacks,  as 
they  are  a  fair  type,  somewhat  above  the  majority  of  their 
neighbors  ;  and  because  I  am  enabled  to  follow  closely  the 
excellent  description  of  their  traditions  and  customs  by  Dr. 
Peschuel-Loesche  in  the  Zeitschrift  fuer  Ethnologie  for  1878 
(Inidiscretes  aus  Loango,  p.  17).  Menstruation  seems  to  be- 
gin with  the  thirteenth,  more  rarely  the  twelfth  year,  and  the 
cleanliness  of  the  people  does  not  permit  an  interruption  of 
the  daily  bath,  even  during  the  continuance  of  the  monthly 
flow.  The  idea  of  uncleanliTiess  during  the  period,  and  dur- 
ing child-bed,  prevails  among  the  Loango  women,  as  among 
most  of  their  neighbors  ;  and  while  menstruating  a  female 
must  not  approach  or  enter  the  huts  of  men.  Woman, 
among  the  Loangos,  ranks  higher  than  among  most  African 
tribes,  and  instead  of  the  long,  pendent,  breast  which  the 
negroes  ordinarily  cultivate,  the  Bafioto  woman  prides  her- 
self upon  a  firm  mamma,  and  binds  or  straps  the  breast  in 
case  it  threatens  to  drag  ;  hence  a  Loango  woman  does  not 
develop  a  long  breast,  and  is  never  seen,  like  many  of  her 
black  sisters,  carrying  on  her  back  a  suckling  child,  which  is 
nursing  the  breast  thrown  over  the  shoulder. 

They  are  amoral  people;  religious  ceremonies,  continuing 
many  days,  accompany  the  appearance  of  menstruation 
in  the  girl ;  for  days  she  is  isolated ;  strict  laws  govern  the 
act  of  cohabitation,  and  the  seduction  of  a  maiden  is  looked 
upon  as  a  misfortune  which  has  befallen  the  entire  land. 
They  delight  in  children ;  hence  abortion,  as  may  be  sup- 
posed, rarely  occurs  among  this  people,  although  sometimes 
practiced  by  elderly  females  of  immoral  character,  who 
dread  confinement ;  and  they  effect  it  by  eating  freely  of  red 
pepper,  and  by  kneading  and  compressing  the  abdomen. 

Twins  and  triplets  are  not  killed ;  deformed  children  are 
quickly  put  aside  ;  such  as  have  only  slight  deformities  are 
sometimes  permitted  to  live  ;  but  even  a  mother's  love  cauiiot 


210  LABOR:  AN  ETHNOLOGICAL  STUDT. 

save  them  in  case  that  popular  feeling  should  be  such  as 
to  consider  them,  for  some  reason  or  other,  as  possessed  of 
any  witchcraft. 

It  depends  merely  upon  an  accidental  combination  of 
circumstances  whether  an  ill-formed  child  is  doomed  as  a 
"  ndodschi"  (deformed  bearer  of  misfortune),  or  simply  as 
a  "  muana-mu-bi"  (ugly,  bad  child) ;  no  fault  is  found  with 
the  mother.  This  superstition  may  go  so  far  as  to  accuse  a 
still  unborn  child ;  the  mother  is  then  given  a  poison  bark, 
which  is  used  in  the  official  test  ordeals,  in  the  firm  belief 
that  the  "  ndodschi,"  if  such  a  one  exists,  will  be  rendered 
harmless  by  being  aborted — in  case  the  mother  should  die 
in    the  ordeal  her  guilt  is   thus  proven. 

The  pregnant  woman  is  not  forbidden  to  cohabit ;  she 
avoids  garments  of  a  red  color,  wearing  white  or  blue,  or 
simple  native  bark-fiber ;  she  drinks  no  more  rum  lest  the 
child  should  be  marked,  but  this  superstition  is  rapidly 
losing  ground.^  Charms  favorable  to  women  are  erected  in 
the  hut,  and  worn  upon  the  body — wise  women,  "  ngangas" 
and  neighbors  are  of  course  consulted. 

The  act  of  parturition  is  not  difficult  as  a  rule,  and 
within  a  few  hours  the  mother  is  enabled  to  again  take 
up  her  accustomed  work.  Skilled  assistance  of  any  kind 
is  unknown — men  are  not  permitted  to  be  about.  In 
difficult  cases  the  neighboring  huts,  with  a  feeling  of 
delicacy,  are  cleared;  the  children  sent  out  of  the  village, 
and  the  assistants  raise  their  voices  in  order  to  drown 
the  lamentations  of  the  patient  in  the  general  noise.  Con- 
finement takes  place  whilst  the  patient  is  standing,  lean- 
ing against  the  wall,  or  kneeling,  inclined  forward,  resting 
upon  her  arms,  because  the  desired  head-presentation  is  sup- 
posed to  come  about  most  readily  in  this  position.  The 
child  is  caught  upon  a  bit  of  cloth  or  matting,  that  it  may 
not  touch  the  ground.  If  labor  is  retarded,  the  patient 
seeks  her  couch,  casts  herself  down  prone  upon  her  stomach, 
and  thus  seeks  to  further  labor  by  mechanical  pressure.  If 
expulsion  is  not  furthered  by  these  means,  the,  assembled 

*  Evidently  a  very  decided  proof  of  advancing  civilization. 


THE   YELLOW,  BLACK,  AND  RED  RACES.  211 

women  take  cliarge  of  the  case,  especially  if  a  primipara ; 
arms  and  legs  are  seized,  whilst  some  old  woman,  who 
squats  down,  takes  the  head  of  the  patient  upon  her  lap, 
presses  a  gag  firmly  upon  mouth  and  nose  in  order  to  choke 
the  sufferer,  so  that  finally  the  child  is  forced  out  amid  the 
spasmodic  convulsions  that  follow.  These  means  rarely 
fail — better  ones  at  least  are  not  known.  Rupture  of  the 
perineum  is  not  unfrequent.  If  a  woman  is  overtaken  with 
labor  pains  away  from  friends  and  help,  she  prevents  at  least 
that  the  child  should  fall  to  the  ground  and  carries  it  home 
well  covered. 

The  placenta  is  wrapt  up  and  buried — secrecy  of  their 
labors  seems  to  be  entirely  due  to  the  prevalent  feeling  of 
modesty.  The  navel  string  is  measured  off  to  the  double 
length  of  the  first  joint  of  the  thumb,  or  to  the  knee,  and 
is  then  cut,  not  with  a  knife,  but  with  a  sharp  edge  of  a 
leaf-stalk  of  the  oil  palm.  The  assistants  then  seat  them- 
selves, about  a  fire  which  has  been  lighted  in  the  hut,  and 
pass  the  new  born  babe  from  lap  to  lap,  whilst  with  well- 
warmed  hands  the  navel  string  is  compressed  and  its  drying 
off  thus  greatly  hastened.  This  object  is  attained  within 
twenty-four  hours  ;  the  parched  and  deadened  remnant  is 
thrust  off  with  the  thumb  nail  and  cast  into  the  fire,  lest  it 
should  become  food  for  the  rats.  If  this  should  be  devoured 
by  them  the  child  grows  up  wicked.  Until  the  cord  has  been 
separated  from  the  body  and  has  been  burnt,  no  male,  not 
even  the  father,  is  admitted  to  the  hut. 

During  the  first  days  the  child  is  not  given  the  breast — 
the  qualities  of  the  colostrum  seem  recognized ;  at  least 
this  is  called  "tschida  fuenna,"  and  the  milk  later 
"tschiali."  In  order  to  further  the  flow  of  milk  the  young 
mother  drinks  hot  water  for  many  months,  and  washes  her- 
self with  a  decoction  of  the  leaf  of  the  castor-bean  plant. 
The  genitals  are  cleansed  and  rubbed  with  bunches  of  these 
same  leaves,  well  soaked  in  water,  until  all  secretions 
cease. 

The  young  mother  takes  frequent  baths  in  some  secluded 
spot,  not  too  far  from  her  hut ;  she  seats  herself  in  a  slight 


212  LABOR:  AN  ETHNOLOGICAL  STUDT. 

excavation  in  tlie  ground,  which  has  been  lined  with  mats, 
and  whilst  her  assistants  or  friends  are  pouring  hot  and  cold 
water  alternately  over  her  body,  she  is  thoroughly  kneaded 
and  rubbed — massage.  The  child,  especially  in  case  that  it 
should  perspire,  is  bathed  several  times  a  day  in  cold  wa- 
ter, into  which  charms  have  been  dipped.  The  new  born 
child  remains  within  the  hut  for  two  or  four  months.  The 
father  and  other  men  can  only  see  it  after  the  navel  string 
has  separated  from  the  body,  and  even  then  only  if  they 
have  not  cohabited  during  the  preceding  night.  The  ne- 
groes themselves  assign  the  suspicion  of  their  wives  as  a 
reason  for  this  exclusion,  because  they  wish  to  retain  con- 
trol of  them  and  prevent  them  from  becoming  dissolute,  as 
mothers  are  prohibited  from  sexual  intercourse  during  the 
period  of  lactation.  This  period  averages  twelve  or  four- 
teen months,  but  varies  greatly,  as  some  wean  their  chil- 
dren when  the  first  teeth  appear ;  others  when  they  begin  to 
talk.  No  Loango  mother  trusts  her  child  to  the  care  of  an- 
other;  they  nurse  the  child  just  as  civilized  mothers  do ; 
they  even  hold  down  the  breast  with  the  fingers  in  the  same 
manner.  The  breast  is  only  given  at  certain  times,  no 
other  food  being  offered  in  the  intervals.  The  child  seizes 
a  part  of  the  areola  in  addition  to  the  entire  nipple. 

During  the  first  months,  while  the  child  is  carefully  con- 
fined to  the  hut  in  which  it  was  born,  the  mother  goes  out 
at  will  attending  to  her  duties  ;  but  the  homes  of  the  men  she 
dare  not  enter,  not  even  that  of  her  husband,  whose  visits  she, 
however,  receives,  as  the  father  loves  to  fondle  his  baby ; 
later,  the  mother  carries  her  baby  in  a  cloth  tied  to  her 
back,  and  even  sometimes  quite  a  large  child  is  carried 
astraddle  of  her  hips,  a  position  in  which  the  father  is 
proud  to  carry  about  even  his  good-sized  offspring.  The 
Loango  mother  is  very  fond  of  her  child,  and  it  is  no  won- 
der, when  we  consider  the  attractive,  oddly  humorous,  jolly 
appearance  of  the  little  negroes.  Whilst  the  children  are 
confined  to  the  hut,  two  names  are  given  them — a  boy  is 
■  called  Nsau  (elephant),  a  girl,  Mputa  (lovey,  cliickey). 
Their  first  appearance  outside  of  (lie  lint  gives  rise  to  a  holi- 


THE   TELLOW,  BLACK,  AND  RED  RACES.  213 

day  ;  the  mother,  in  festive  garments,  receives  the  villagers 
and  their  congratulations,  whilst  seated  in  front  of  her  hut 
with  her  child  upon  her  arms.  A  name  is  given  the  new- 
comer with  a  kind  of  baptism  by  some  relative,  usually  the 
uncle,  and,  if  we  may  so  express  it,  citizenship  is  thereby 
extended  to  him. 


THE  RED  RACES. 


Primitive  customs  among  our  North  American  Indians 
are  rapidly  disappearing.  As  the  war-bonnet  of 
eagle  plumes  has  given  way  to  the  unromantic  felt  hat — 
the  tomahawk  and  bow  and  arrow  to  the  revolver  and 
breech-loading  rifle — so  are  the  original  obstetric  customs, 
traditionary  among  the  red  people  for  ages,  yielding  to  the 
intluence  of  civilization :  the  few  warlike  tribes,  w^ho  still 
retain  the  ways  of  their  ancestors,  are  rapidly  dying  out ; 
those  who  have  quietly  settled  down  upon  the  reserva- 
tion are  accepting  the  habits  of  the  whites,  and  their  par- 
turient squaws  are  delivered  as  they  have  been  taught  by 
the  agency-physician  or  the  army-surgeon ;  in  fact,  primi- 
tive obstetric  customs  are  so  speedily  passing  away  that 
more  than  one  of  the  agency-physicians  answered  with 
some  surprise  to  the  circular,  kindly  sent  among  them,  for 
me,  by  the  Smithsonian  Institute,  that  he  had  observed 
nothing  peculiar ;  that  the  squaws  of  the  tribe  were  deliv- 
ered on  the  back,  and  their  habits  were  the  same  as  those 
of  their  white  sisters.  Many  of  the  tribes,  nevertheless, 
still  retain  their  peculiar  customs,  but  all  of  my  informants 
unite  in  the  statement  that  it  is  very  difficult  to  obtain  any 
information  from  them  upon  these  points.  It  is  rare  that 
men  are  permitted  to  witness,  or  even  be  near  a  labor 
scene;  and  white  physicians  are  not  called  in  unless  it  be 
a  desperate  case.  Indians  are  moreover  very  reticent  upon 
this  point  and  very  unwilling  to  impart  any  information 
regarding  their  women  or  the  functions  peculiar  to  them ; 


214  LABOR:  AN  ETHNOLOGICAL  STUDT. 

this  is  strange,  too,  as  they  are  hy  no  means  a  modest 
people. 

There  are  many  points  of  resemblance  in  the  obstetric 
customs  of  the  various  Indian  tribes,  and  in  many  features 


Fig.  57— Kiowa  Labor. 

they  differ.  The  kneeling  posture,  for  instance,  is  the  one 
most  commonly  assumed  by  the  squaw  in  labor,  and  yet 
among  certain  tribes  almost  all  the  other  positions  can  be 
found,  though  rarely  that  upon  the  lap  of  the  husband; 
this  is  a  trouble  and  indignity  which  the  laziness  and  pride 
of  the  Indian -brave  will  not  submit  to. 

As  I  cannot  detail  the  customs  of  the  various  tribes,  I 
will  confine  myself  to  the  obstetric  practice  of  the  Indians 
of  the  northwest,  and  of  the  more  easterly  prairie  tribes. 
As  regards  the  former  I  shall  accept  the  statement  of  Dr. 
John  Field,  of  Sheridan,  Oregon,  who  has  given  the  follow- 
ing very  interesting  account  of  his  long  stay  among  the 
tribes,  especially  while  physician  to  the  Grand  Ronde 
Agency  in  Oregon;  he  says  : 


the  tellow,  black,  and  red  eaces.         215 

The  Indians  of  the  Pacific  Coast. 
\Yomen  belonging  to  the  Indian  tribes  on  the  northwest 
coast  are  attended  in  kibor  by  a  number  of  older  squaws, 
as  many  as  may  be  necessary.  These  attendants  are  not 
especially  skilled  midwives,but  the  mothers,  if  living  near 
enough,  or  some  other  older  friend  and  a  few  of  the  neigh- 
bors. It  is  among  these  people  as  it  is  among  the  whites, 
there  is  alwaj^s  some  old  woman  in  every  tribe,  band  or 
settlement,  who  is  looked  upon  as  an  authority  in  these 
cases,  who  is  considered  an  expert  manipulator  and  whoso 
every  order  or  suggestion  is  implicitly  obeyed. 

During  the  first  stage  of  labor,  the  patient  will  usually 
keep  on  her  feet,  moving  about  the  lodge,  or  now  and 
then  lying  on  her  bed  for  a  short  period  at  a  time.  At  the 
recurrence  of  each  pain  the  parturient  will  frequently  utter 
a  plaintive  cry.  In  this  she  differs  somewhat  from  her 
white  sister,  who  will  most  generally  announce  the  occur- 
rence of  pain  by  a  sound  which  has,  by  the  old"  women, 
been  determined  "grunt,"  ''grunting;"  the  former  gives 
vent  to  alow,  plaintive  cry,  which  the  word  "wail"  or 
"  whine  "  seems  to  express  more  nearly  than  any  other. 
"When  the  parturient  lies  down  she  usually  reclines  upon 
her  back,  with  the  legs  semi-flexed  upon  the  thighs,  the 
thighs  likewise  flexed  upon  the  body. 

No  assistance  is  rendered  at  the  time  of  a  pain  during 
the  first  stage,  but  the  attendants  are  all  ready,  and  willing 
to  help  when  the  proper  time  comes. 

The  patient  takes  to  her  bed  and  lies  on  her  back — her 
head  slighly  elevated.  This  bed  or  pallet  is  universally  on 
the  floor,  and  near  the  fire  if  the  weather  is  cold.  Her  legs 
are  well  flexed  upon  her  thighs,  and  her  thighs  upon  her 
abdomen  ;  knees  and  feet  are  each  supported  by  an  assist- 
ant ;  she  herself  usually  uses  her  hand  to  press  against  her 
thighs,  or  when  the  pains  become  severe,  to  compress  her 
own  abdomen  over  the  fundus  uteri. 

The  officiating  accoucheur— if  the  term  is  allowable — 
crouches  upon  the  pallet  at  the  feet  of  the  parturient,  with 
her  hands  pressed  upon  the  nates,  perineum  ^nilva  or  ab* 


216  LABOR:  AN  ETHNOLOGICAL  STUDY. 

domen  of  patient,  as  circumstances  in  her  judgment  may 
require. 

She  does  not  rely  upon  vaginal  examination,  nor  indeed 
does  she  at  all  practice  that  means  either  of  diagnosis  or 
assistance  to  her  patient. 

As  the  case  progresses,  and  the  expulsive  pains  increase 
in  severity,  the  abdomen  of  the  parturient  is  firmly  com- 
pressed over  the  fundus  uteri  by  the  hands  of  an  assistant. 
She  now  uses  her  own  hands  to  press  upon  her  thighs,  and 
does  not  pull  at  the  hands  of  an  attendant  as  so  many 
white  women  do. 

The  abdominal  manipulations  before  referred  to  are 
practiced  by  an  assistant,  kneeling  by  the  side  of  the 
patient,  with  her  face  towards  the  patient's  feet.  She 
spreads  her  fingers  in  such  a  manner  as  to  grasp  the  entire 
fundus  uteri  as  nearly  as  possible.  When  the  uterus  is 
being  contracted  by  the  force  of  nature  the  assistant  fol- 
lows the  fundus  with  her  hands,  firmly  grasping  the  organ, 
and  gently  but  firmly  pressijig  downward.  When  the 
pain  subsides,  she  still  keeps  her  firm  hold  of  the  uterus, 
and  does  not  allow  it  to  relax,  at  least  she  does  all  she  can 
to  prevent  this. 

If  the  case  is  a  tedious  one,  and  the  head  is  slow  to  pass, 
another  method  is  resorted  to  in  addition  to  the  one 
mentioned. 

The  woman  is  seized  by  two  attendants,  who  grasp  her 
around  the  thorax,  immediately  under  the  arms,  raise 
her  body  off"  the  bed,  and  support  her  in  an  erect  position, 
so  far  as  her  body  is  concerned.  She  is  permitted  to  rest 
upon  her  knees  or  feet,  according  to  the  peculiar  notion  of 
the  accoucheuse,  or  according  to  attending  circumstances. 

By  these  means,  and  in  the  position  above  mentioned,  she 
is  as  firmly  supported  as  is  possible  for  the  attendants  to 
do. 

The  abdominal  pressure  is  firmly  kept  up  until  the  end 
of  the  labor. 

The  accompanying  illustration,  although  a  labor  scene 
among  the  Mexican  Indians  in  the  vicinity  of  San  Luis 


THE   YELLOW,  BLACK,  AND  RED  RACES. 


217 


Potosi,  and  there  photographed  for  me  by  Dr.  Gr.  Barroeta, 
so  well  represents  the  relative  position  of  patient  and  as- 
sistants, as  here  described,  that  I  have  inserted  it. 


Fig.  58.— Mexican  Indians. 

Towards  the  close,  and  while  the  woman  is  in  the  posi- 
tion  last  named,  the  accoucheuse  remains  crouched  a,t  the 
feet  of  the  parturient,  supporting  the  perineum  and  vulva 
with  the  palms  of  her  hands.  As  soon  as  the  head  emer- 
ges fully  through  the  vulva,  the  accoucheuse  takes  it 
between  her  hands  and  makes  traction  so  that  the  shoul- 
ders and  body  of  the  child  will  be  the  more  speedily 
delivered. 

The  child  is  received  into  the  lap  of  the  accoucheuse 
whether  the  mother  is  in  the  erect  position  or  lying  down. 

The  umbilical  cord  is  tied  and  divided  in  a  few  moments 
after  delivery,  and  the  child  is  laid  to  one  side  out  of  the 
way.     The   delivery  of  the  placenta  is  expected  at  once 


218  LABOR:  AN  ETHNOLOGICAL  STUDT. 

after  the  birth  of  the  child  and  without  further  trouble  ;  in 
order  to  facilitate  speedy  expulsion  the  accoucheuse  and 
assistants  resort  to  certain  manipulations. 

This  effort  to  assist  the  uterus  in  casting  off  the  pla- 
centa is  made  immediately  after  the  child  is  born,  and 
stowed  away  in  a  safe  place. 

If  the  case  has  been  an  easy  one,  and  the  woman  has 
not  been  raised  from  her  couch,  the  first  efforts  to  obtain 
the  placenta  are  made  as  she  lies  there,  the  accoucheuse, 
making  gentle  but  tolerable  firm  traction  on  the  cord  with 
one  hand,  manipulates  the  uterine  globe  with  the  other. 
At  the  same  time,  if  thought  necessary,  an  assistant  will 
press  (by  spreading  the  fingers  of  both  hands)  and  even 
kneed  the  abdomen,  with  the  view  of  pressing  the  secun- 
dines  out  of  the  uterine  cavity.  If  these  efforts  fail  while 
the  woman  is  in  the  recumbent  posture,  she  is  raised  to  the 
erect  position,  and  thus  supported,  as  in  cases  of  difficult 
delivery  of  the  child.  The  uterine  globe  is  then  firmly 
pressed  and  kneeded,  whilst  the  accoucheuse  makes  more 
or  less  firm  traction  upon  the  cord. 

But  if  the  case  should  be  one  of  abnormal  attachment, 
or  hour-glass  contraction,  they  know  no  method  of  pro- 
cedure that  promises  success.  Frequently  the  patient  will 
survive,  escaping  blood  poisoning,  and  the  secundines  will 
be  cast  off  in  a  state  of  disorganization. 

By  making  persistent  inquiries  I  learn  that  they  seldom 
fail  in  sufficiently  stimulating  the  uterus  to  cast  off  the 
placenta. 

After  Treatmettt. 
The  treatment  resorted  to  after  delivery  is  not  alike  among 
all  tribes.  Some,  with  whom  I  have  come  in  contact,  re- 
quire the  puerpera  to  keep  up  on  her  feet  during  the  greater 
part  of  the  day — taking  short  walks  about  the  camp,  rest- 
ing when  weariness  becomes  oppressive  ;  while  walking 
she  uses  a  staff,  for  the  double  j^urpose  of  support  while 
upon  her  feet,  and  also  as  an  instrument  of  relief ;  as  she 
slowly  steps  about  the  body  is  frequently  bene  forward, 


THE   YELLOW,  BLACK,  AND  RED  RACES.  219 

bringing  the  abdominal  walls  immediately  over  the  uterus 
against  the  upper  end  of  the  staff,  while  the  hand  of  the 
woman  is  upon  the  end  of  the  stick  in  the  same  way  as  that 
of  a  man  walking  with  a  cane. 

This  practice  is  kept  up  for  a  period  of  three  or  four 
days,  when  the  puerpera  is  thought  to  be  well ;  the  pre 
scribed  walks  varying  with  periods  of  rest  upon  her  couch. 

The  object — as  I  am  informed  by  the  old  women  of  the 
tribe — is  to  facilitate  the  flow  of  the  lochia. 

They  know  that  a  certain  amount  of  blood  should  escape, 
and  think  that  if  the  patient  should  lie  down  in  bed  this 
would  accumulate  in  the  abdominal  cavity,  and  cause  death. 
From  all  I  can  learn,  by  inquiries  of  those  of  the  tribes 
who  are  old  enough  to  remember  the  practice  among  the 
Indians  in  this  region  before  the  time  that  the  white  man 
came  among  them,  this  procedure  in  the  after-treatment  was 
solely  for  the  purpose  of  encouraging  a  free  flow  of  the 
lochia,  and  I  further  learn  that  no  case  of  death  from  hem- 
orrhage had  then  been  known  to  occur. 

Some  of  the  Indian  tribes  in  this  country  follow  a  difler- 
ent  course  of  after-treatment. 

As  soon  as  possible  after  delivery  the  puerpera  is  placed 
on  a  bed  on  the  floor  of  the  lodge,  and  securely  wrapped  in 
blankets,  or  whatever  kind  of  covering  they  have.  The 
bed  is  placed  near  the  fire,  if  the  weather  is  cool,  and  she  is 
kept  in  this  closely  wrapped  condition.  "When  asking  for 
an  explanation  of  this  method  of  treating  their  lying-in 
women,  I  was  told  that  it  was  to  keep  the  patient  from  taking 
cold,  and  having  fever  (somewhat  like  the  Siamese).  In  this 
condition  she  is  kept  for  the  period  of  four  or  five  days, 
except  such  times  as  she  is  compelled  to  attend  the  calls  of 
nature.  "When  freed  from  this  restriction,  she  at  once  re- 
sumes the  care  of  the  babe  as  well  as  the  duties  naturally 
falling  to  the  lot  of  an  Indian  squaw. 

During  the  period  that  I  was  living  among  these  Indians 
— two  and  one-half  years — I  neither  saw  or  heard  of  a  case 
of  puerperal  fever,  eclampsia,  or  any  other  diseases  pecu- 
liar to  the  lying-in  woman.    Neither  did  a  death  during 


220  LABOR:  AN  ETHNOLOGICAL  STUDT. 

confinement  come  under  my  immediate  observation,  and 
but  few  Indian  women  have  any  mammary  trouble  after 
tlieir  confinement,  notwithstanding  the  fact  that  they  are 
exposed  to  the  same  cause  that  is  a  prolific  source  of  such 
complications  among  whites. 

Easteris"  Tribes. 

As  it  is  impossible  for  me  to  make  use  of  all  of  the  ex- 
tremely valuable  and  interesting  information  received  by 
kindly  responses  from  the  surgeons  of  the  army  and  agen- 
cies among  the  various  Indian  tribes,  I  will  close  with  a  de- 
scription of  the  obstetric  customs  among  the  more  easterly 
tribes,  theCheyennes,  Arapahoes,  Kiowas,  Comanches,  and 
eastern  Apaches,  given  me  by  Maj.  "W.  H.  Forwood,  U.  S.  A., 
now  stationed  at  Fort  Omaha,  Nebraska*  Maj.  Forwood 
resided  for  over  five  years  among  these  tribes,  who  are  scat- 
tered over  the  plains  of  Kansas,  Nebraska,  Colorado  and 
the  Indian  Territory,  and  constantly  came  in  contact  with 
them  at  Forts  Larned  and  Sill,  where  they  congregated  and 
frequently  applied  for  treatment.    He  says : 

"  The  customs  prevailing  among  the  above  named  tribes 
are  similar,  and  the  following  instance  may  well  character- 
ize them : 

"  In  August,  1869,  at  Fort  Sill,  I.  T.,  I  was  called  upon  by 
a  few  men  and  squaws  of  the  Comanche  tribe  for  the  pur- 
pose of  securing  my  services  in  the  case  of  a  patient  who 
had  born  two  children,  and  had  had  difficulty  at  both  of 
her  confinements.  They  anticipated  difficulty  again,  and 
this  was  the  reason  for  summoning  me,  which  otherwise 
would  not  have  been  considered  necessary.  At  the  proper 
time  I  rode  to  the  encampment  on  Cache  Creek,  a  few  miles 
from  the  Post,  where  I  found  the  lodges  pitched  in  a  wide 
circuit  on  high  open  ground,  near  the  stream.  A  short  dis- 
tance outside  the  camp,  and  in  rear  of  the  patient's  family 
lodge,  were  arranged  the  accommodations  for  the  confine- 
ment. A  shelter  had  been  constructed  of  green  boughs  six 
or  seven  feet  high,  by  setting  up  brush  or  bushes,  with  the 
leaves  on,  around  the  circumference  of  a  circle,  about  eight 


THE   YELLOW,  BLACK.  AND  RED  RACES.  221 

feet  in  diameter.  An  entrance  was  provided  by  breaking 
the  circle  and  overlapping  the  two  unjoined  ends.  In  a  line 
outside  the  entrance  were  three  stakes,  ten  paces  apart,  set 
firmly  upright  in  the  ground,  four  feet  high,  made  from  the 
stems  of  small  saplings  with  the  bark  left  on. 

''  Inside  of  this  shelter  were  two  holes  for  the  reception  of 
fluids  of  any  kind  and  the  steaming  of  the  parts,  and  stakes 
for  the  support  of  the  parturient.  Three  stakes  were  also 
planted  outside  of  this  enclosure,  so  that  the  patient,  when 
surprised  by  a  pain,  as  she  walks  about  in  the  intervals, 
may  at  once  kneel  down  and  find  a  support.  (See  Fig.  15, 
and  for  full  description  p.  85.  Posture.)  So  my  patient 
was  walking  about  with  her  assistant,  a  female  relative, 
and  as  each  pain  came  on  she  knelt  down,  grasping  a  stake, 
whilst  the  assistant,  standing  or  kneeling  behind  her, 
seized  her  about  the  waist  and  kneaded  and  compressed 
the  abdomen. 

"  She  was  a  full  Comanche  squaw,  aged  about  20,  of  slight 
frame,  in  good  general  health ;  had  given  birth  to  two 
healthy  children,  but  had  suffered  tedious  labor  with  both, 
and  some  delay  in  the  discharge  of  the  placenta.  Her 
dress  consisted  of  a  body,  a  skirt,  and  two  leg  pieces  made 
of  deer  skin,  and  nicely  ornamented  with  beads,  silver 
shells,  etc.  The  body  was  of  one  skin,  with  a  hole  in  the 
middle  for  the  head,  the  ends  coming  down  in  front  and 
rear,  fastened  at  the  sides  under  the  arms,  making  a  sort  of 
flowing  sleeve,  and  reaching  below  the  waist.  The  skirt  piece 
was  of  about  two  skins,  merely  wound  around,  extending  a 
little  below  the  knees,  and  secured  by  a  leather  belt  at  the 
waist.  The  leggings  were  separate  pieces,  with  moccasins 
attached,  extending  above  the  knees,  fastened  by  a  narrow 
strip  at  the  outside  to  the  waist-belt,  colored,  fringed  and 
ornamented  at  the  leg ;  flowing  hair,  beads  at  the  neck, 
and  a  number  of  brass  rings  about  the  wrists.    • 

"  Examination,  to  which  she  had  submitted  with  evident 
disgust  and  not  without  some  j)ersuasion,  revealed  the  mem- 
branes ruptured,  waters  escaped,  parts  rather  dry,  but  head 
presenting  favorably,  and  pains  moderately  strong,  so  that 


222 


LAB  OR:  AN  E  THNOL  O  GICAL  S  TUD  T. 


tlie  labor  was  deemed  practical  within  a  reasonable  time  by 
the  efforts  of  nature.  "Without  making  any  suggestions  or 
offering  further  interference,  I  sat  down  to  "  make  medi- 
cine," as  they  thought,  but  in  reality  to  improve  the  oppor- 
tunity for  observation.  The  patient  was  assisted  by  a 
woman  of  middle  age  and  some  experience  in  such  cases, 
while  a  considerable  number  of  other  squaws  of  all  ages 
thronged  around,  making  suggestions,  talking,  singing, 
groaning  and  gesticulating,  but  no  men  came  near. 


Fig.  59. — Iviowa  midwife  blowing  an  emetic  into  patient's  mouth. 

"  She  never  assumed  the  recumbent  position,  nor  did  the 
assistant  make  any  attempt  at  vaginal  examination.  There 
was  no  great  effort  on  her  part  to  restrain  the  feelings  or 
submit  j)atiently  to  suffering,  and  the  throng  of  women  in- 
side and  out  kept  up  a  continual  noise  and  clatter.  Mean- 
time the  chief  medicine  man  of  the  tribe  in  a  neighboring 
lodge  was  making  strenuous  exertions  to  help  the  patien 
by  means  which  I  was  not  permitted  to  see,  but  which  could 
be  plainly  heard  going  on  incessantly.     The  ceremony  was 


THE  YELLOW,  BLACK,  AND  RED  RACES.  223 

performed  alone  in  ti  closed  lodge,  with  fire,  and  consisted, 
so  far  as  I  knew,  in  drumming,  singing,  shouting,  dancing, 
running  round  the  fire,  jumping  over  it,  manoeuvring  with 
knives,  and  the  like  antics.  Medicine  making  of  this  sort 
is  very  common  among  the  Indians,  and  is  always  conduct- 
ed with  great  solemnity  and  seriousness,  and  with  full  faith 
in  its  effect.  The  rationale  is  based  on  the  idea  that  dis- 
ease is  an  evil  spirit  entering  the  patient,  and  must  by  some 
magic  infiuence  be  coaxed,  scared  or  driven  out.  The  in- 
ternal administration  of  medicine,  excepting  emetics,  is  sel- 
dom practiced,  and  emetics  are  scrupulously  avoided  in 
cases  of  labor,  owing  to  the  direction  in  which  they  act. 
But  in  the  midst  of  a  vast  amount  of  sheer  nonsense  they 
possess  some  good  practical  ideas,  such  as  the  buffalo  hair 
pessary  worn  with  benefit  by  many  women,  the  hot  stone  in 
labor,  which  is  sometimes  modified  into  a  steam  bath  by 
covering  the  shelter  tightly  with  skins  and  pouring  water 
on  the  stone.  At  a  former  confinement  of  the  patient,  a 
practical  application  had  been  made  of  the  effect  of  fear  in 
routing  the  child  from  its  lodging  place.  She  was  brought 
out  on  the  plain,  and  Eissehaby,  a  noted  chief,  mounted  on 
Ms  swiftest  steed,  with  all  his  war  paint  and  equipments 
on,  charged  down  upon  her  at  full  speed,  turning  aside  only 
at  the  last  moment,  when  she  expected  to  be  pierced  through 
the  body  and  trampled  under  foot.  This  is  said  to  have 
caused  an  immediate  expulsion  of  the  child. 

"As  the  crisis  was  evidently  approaching,  another  exam- 
ination was  made,  with  the  patient  on  her  back  on  a  robe, 
and  the  child  was  soon  born,  the  placenta  following  a  few 
moments  later.  Immediately  the  greatest  excitement  pre- 
vailed, the  monotonous  songs  and  doleful  cries  were 
changed  to  sounds  of  rejoicing,  and  the  noise  and  din  were 
louder  than  ever,  but  of  a  far  more  pleasant  character.  The 
moment  the  placenta  escaped  the  patient  sprang  up,  buckled 
on  a  stout  leather  belt,  mingled  with  the  crowd  and  soon 
disappeared,  without  apparently  taking  the  slightest  notice 
of  her  child.  I  took  up  the  baby  and  offered  it  to  some  of 
the  bystanders,  but  each  one  shrank  back  and  would  not 


224  LABOR:  AN  ETHNOLOGICAL  STUDY. 

even  touch  it.  Presently  a  woman,  whom  I  had  not  seen  be- 
fore, appeared  and  took  charge  of  it.  She  was  assigned  to 
the  duty  of  receiving  and  having  the  little  stranger  initiated 
into  the  world  with  proper  ceremony.  This,  in  case  of  a 
boy,  would  probably  be  some  simple  little  nonsense  j)er- 
formed  by  an  old  chief,  and  in  case  of  a  girl,  by  the  squaw 
herself. 

"An  instance  came  under  my  notice  once  in  which  an  im- 
aginary object  (a  ball  it  was  said  to  be)  was  blown  into  the 
mouth  and  placed  down  in  the  ribs  somewhere  about  the 
heart,  where  it  was  to  remain,  the  supposed  effect  being  to 
give  courage  and  protect  against  harm.  The  medicine  chief 
approached,  and  placing  his  two  hands  in  front  of  his  chest 
and  throat,  made  a  gulping  effort  as  though  bringing  some- 
thing up  out  of  his  own  body,  leaned  over  and  blew  quickly 
into  the  patient's  mouth,  and  the  thing  was  done. 

"The  Indians  tie  the  cord  with  one  ligature  and  cut  it  al- 
most a  foot  from  the  child's  body.  The  placenta  is  then 
secretly  and  mysteriously  disposed  of  in  various  ways  not 
unlike  those  often  practiced  by  old  women  among  ourselves. 
Their  resources  in  case  of  retained  placenta,  so  far  as  I  know, 
are  limited  to  forcible  compression  of  the  abdomen,  traction 
upon  the  cord,  and  efforts  to  reach  it  with  the  hand  in  the 
vagina,  in  which  the  patient  as  well  as  the  assistant  take 
part.  They  never  neglect  to  pay  the  doctor  his  fee,  lest  he 
should  become  angry,  and,  by  the  power  of  his  arts,  bring 
some  calamity  upon  the  patient  in  future,  and  that  ceremony 
was  not  overlooked  in  this  instance.  I  was  brought  to  the 
chief's  lodge  and  formally  presented  with  a  pony  of  my  own 
selection,  but,  as  they  feared  the  poor  creature  would  be  very 
lonely  away  from  its  companions,  I  was  requested  to  let  it 
run  with  the  herd,  and  consider  it  mine — with  the  herd  of 
course  it  remained." 

A  surgeon  who  has  been  stationed  for  some  years  at  Camp 
Sheridan,  in  the  Spotted  Tail  Indian  Agency,  in  the  midst 
of  from  seven  to  twelve  thousand  Sioux  Indians,  principally 
of  the  great  Brule  branch  of  the  nation,  and  who  has  care- 
fully inquired  into  their  customs,  writes  :  "  My  inquiries  into 


THE   YELLOW,  BLACK,  AND  RED  RACES.  225 

their  obstetric  habits  were  attended  with  difficulties,  as 
these  Indians,  never  talkative,  become  quite  reticent  as 
soon  as  any  questions  are  asked  concerning  their  peculiar- 
ities. JSTo  very  definite  custom  or  practice  seems  to  be  fol- 
lowed ;  the  most  common  is,  that  several  matrons  preside 
as  midwives  in  the  lodge  of  the  parturient,  which  is,  espe- 
cially in  delayed  cases,  filled  to  suffocation  with  indiff'er- 
ently  solicitous  (?)  relations  and  friends. 
"During  the  first  stage  the  squaw  sits  or  lies  about  grunt- 
ing vociferously,  but  daring  the  expulsion  of  the  fetus  her 
posture  is  erect,  or  nearly  so,  with  her  arms  around  the  neck 
of  a  stout  male  support,  mostly  a  young  bachelor  buck. 
The  child  is  received  by  the  attendant  squaw,  and  the  pla- 
centa promptly  follows,  as  a  rule.  She  is  then  put  to  bed, 
and  the  lochia  received  on  old  clothes,  which  are  burned. 
"These  Indians,  though  nearly  regardless  of  what  we  con- 
sider as  modesty  w-ith  regard  to  defecation  and  urination, 
are  quite  superstitious  about  the  functions  peculiar  to 
women.  On  the  first  menstruation  of  a  maiden  quite  a 
ceremonious  feast  is  held,  at  which  the  relatives  and  attend- 
ing friends  congratulate  the  maiden,  and  her  parents,  on 
the  dawn  of  her  womanhood,  for  she  is  now  a  woman.  Dur- 
ing the  whole  of  each  menstrual  period  (or  "  moon  in  the 
ass,"  as  they  term  it)  the  female  is  hedged  about  with  re- 
strictions. She  is  considered  unclean,  must  refrain  from 
certain  things,  and  is  disqualified  from  assisting  or  partici- 
pating in  any  of  llie  ceremonies  of  her  tribe. 
"Other  of  their  customs,  also,  are  quite  peculiar.  The 
female  stands  to  urinate  and  sits  during  defecation,  whilst 
the  male  sits  on  his  haunches  to  urinate,  and  stands  during 
defecation  ;  the  male  mounts  his  horse  from  the  right  side, 
the  female  from  the  left." 

Among  the  Indians  of  Montana  the  usual  name  for  a 
child  for  the  first  year  or  two,  before  a  permanent  name  is 
bought  of  the  medicine  man,  is  "  Mai,  Tsa  Barkea-Tsa- 
careash,"  which  is  a  word  applied  to  a  spirit,  and  also  to 
the  gray-crowned  finch  (Leucosticte  tephrocotis),  into  which 
bird  young  children  are  believed  to  enter  on  their  death. 


226  LABOR:  AN  ETHNOLOGICAL  STUDT. 

Twins  cause  their  parents  to  Ibe  greatly  envied  ;  but  if  a 
squaw  'becomes  pregnant  while  still  nursing,  the  child  at 
the  breast  is  said  to  die  in  four  cases  out  of  five  from  diar- 
rhea and  marasmus. 

Among  the  Modocs  and  Klamaths,  the  husband  refrains 
from  eating  all  fiesh  of  fish  or  game  for  five  days  after  the 
'birth  of  a  child,  and  the  mother  refrains  from  the  same  for 
ten  days.  At  each  menstrual  period  the  woman  refrains 
from  flesh  for  five  days  and  is  more  or  less  isolated  from 
the  male  portion  of  the  family,  the  same  custom  prevailing 
after  an  abortion. 

These  five  and  ten  days  periods  are  the  same  I  have 
repeatedly  spoken  of  among  the  natives  of  India  and 
Africa. 

Certain  of  the  tribes  demand  that  the  father  take  to  the 
woods  and  absent  himself  for  some  days  from  the  family 
lodge  and  the  encampment,  and  if  it  be  his  first  child  he 
caches  himself  until  the  child  is  a  week  old. 

It  is  only  the  young  men  who  practice  this,  as  they  are 
so  ashamed  of  the  occurrence. 

At  the  end  of  this  time,  or  as  soon  as  the  father  is  able, 
he  calls  all  his  relations  and  friends  together  and  has  a 
feast  of  boiled  dog — provided  the  child  be  a  male. 

Much  of  this  information,  especially  the  last,  regarding 
the  0-g-a-l-la-l-la  Sioux,  comes  from  the  well  known  In- 
dian Scout,  Will.  E.  Everett. 

Although  I  should  like  to  enter  more  fully  into  the 
customs  of  the  various  Indian  tribes,  the  above  will  suf- 
fice to  show  the  intimate  relation  between  the  obstetric 
customs  among  the  yellow,  black  and  red  races. 

I  have  made  use  of  the  last  three  illustrations,  although 
not  bearing  directly  upon  the  customs  of  the  tribes  here  re- 
ferred to,  on  account  of  their  extreme  interest. 

Figures  57  and  59  I  obtained  through  the  kindness  of 
Capt.  M.  Barber,  surgeon  U.  S.  A.,  of  Fort  Sill,  who  had  them 
made  by  a  Kiowa  artist  to  illustrate  the  customs  of  his 
people. 

Fig.  57  represents  a  labor  scene  in  a  Kiowa  tepee.     The 


THE   TELLOW,  BLACK,  AND  RED  RACES.  227 

patient  is  on  lier  knees,  grasping  a  tent  pole  fastened  at 
riglit  angles  to  two  upright  ones  ;  one  assistant  is  kneading 
her  back,  whilst  another  is  attending  to  the  child  which  is 
in  the  act  of  being  born.  A  gun,  saddle  and  "G"  string, 
the  peculiar  articles  of  male  apparel,  are  hung  at  the  head 
of  the  couch  to  induce  the  birth  of  a  boy. 

Fig.  59  represents  the  midwife  blowing  something  into 
the  patient's  mouth  to  make  her  vomit  and  strain,  and  thus 
assist  the  labor  pains.  She  here  rests  herself  upon  the  pole, 
which  plays  so  important  a  role  in  their  labors,  sometimes 
serving  as  a  support  to  the  kneeling  patient  (fig.  57),  some-  , 

times  as  a  means  of  expression  when  she  leans  upon  it  with  (^ 

her  stomach.  This  scene  is-represented  taking  place  in  the 
"medicine  lodge" — why,  Dr.  Barber  could  not  inform  me. 

Fig.  58  is  taken  from  a  photograph  secured  for  me  by  my 
friend  Dr.  Gr.  Barroeta,  of  San  Louis  Potosi,  Mexico,  and 
well  illustrates  the  posture  of  patient  and  assistants  as  as- 
sumed in  labor  by  the  Indians  of  that  region.  I  have  in 
an  earlier  chapter  described  the  scene  more  in  detail  and 
pictured  it  so  as  to  show  the  position  of  the  assistant's 
hands  ;  here  they  are  concealed,  as  is  customary,  beneath 
the  clothing,  so  as  not  to  expose  the  person  of  the  patient. 


d 


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